|
HC FO INSERT UCBL TYPE
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
905353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
905353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.56 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Adventist Health Commercial |
$284.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$401.96
|
| Rate for Payer: Blue Shield of California Commercial |
$512.17
|
| Rate for Payer: Blue Shield of California EPN |
$337.28
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$485.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$485.80
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.90
|
| Rate for Payer: Vantage Medical Group Senior |
$589.90
|
|
|
HC FOLEY CATH INSERTION TRAY PVP
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.69
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$16.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8.92
|
| Rate for Payer: Galaxy Health WC |
$18.95
|
| Rate for Payer: Global Benefits Group Commercial |
$13.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: Prime Health Services Commercial |
$18.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.15
|
| Rate for Payer: United Healthcare All Other HMO |
$11.15
|
| Rate for Payer: United Healthcare HMO Rider |
$11.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.95
|
|
|
HC FOLEY CATH INSERTION TRAY PVP
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$18.95 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8.92
|
| Rate for Payer: Galaxy Health WC |
$18.95
|
| Rate for Payer: Global Benefits Group Commercial |
$13.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.35
|
| Rate for Payer: Multiplan Commercial |
$17.84
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: Prime Health Services Commercial |
$18.95
|
|
|
HC FOLEY TRAY
|
Facility
|
OP
|
$85.80
|
|
| Hospital Charge Code |
906812274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.69
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Cigna of CA HMO |
$54.91
|
| Rate for Payer: Cigna of CA PPO |
$63.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.06
|
| Rate for Payer: Multiplan Commercial |
$68.64
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.90
|
| Rate for Payer: United Healthcare All Other HMO |
$42.90
|
| Rate for Payer: United Healthcare HMO Rider |
$42.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.93
|
| Rate for Payer: Vantage Medical Group Senior |
$72.93
|
|
|
HC FOLEY TRAY
|
Facility
|
IP
|
$85.80
|
|
| Hospital Charge Code |
906812274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.59
|
| Rate for Payer: Multiplan Commercial |
$68.64
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
OP
|
$129.76
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$145.23 |
| Rate for Payer: Adventist Health Commercial |
$25.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.23
|
| Rate for Payer: Blue Shield of California Commercial |
$86.81
|
| Rate for Payer: Blue Shield of California EPN |
$57.35
|
| Rate for Payer: Cash Price |
$58.39
|
| Rate for Payer: Cash Price |
$58.39
|
| Rate for Payer: Cigna of CA HMO |
$83.05
|
| Rate for Payer: Cigna of CA PPO |
$96.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.84
|
| Rate for Payer: EPIC Health Plan Senior |
$14.70
|
| Rate for Payer: Galaxy Health WC |
$110.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$103.81
|
| Rate for Payer: Networks By Design Commercial |
$84.34
|
| Rate for Payer: Prime Health Services Commercial |
$110.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.91
|
| Rate for Payer: United Healthcare All Other HMO |
$11.91
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| 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: 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 |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
IP
|
$2,275.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$1,933.75 |
| Rate for Payer: Adventist Health Commercial |
$455.00
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.00
|
| Rate for Payer: EPIC Health Plan Senior |
$910.00
|
| Rate for Payer: Galaxy Health WC |
$1,933.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,408.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$1,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,478.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,933.75
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$2,275.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.55 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$455.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,492.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,392.30
|
| Rate for Payer: Blue Shield of California EPN |
$919.10
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cash Price |
$1,023.75
|
| Rate for Payer: Cigna of CA HMO |
$1,456.00
|
| Rate for Payer: Cigna of CA PPO |
$1,683.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$1,933.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,365.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$174.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,517.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$1,820.00
|
| Rate for Payer: Networks By Design Commercial |
$1,478.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,933.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,365.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,365.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.83
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.00
|
| Rate for Payer: United Healthcare All Other HMO |
$65.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.50
|
| Rate for Payer: Vantage Medical Group Senior |
$110.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.14
|
| Rate for Payer: Blue Shield of California Commercial |
$243.54
|
| Rate for Payer: Blue Shield of California EPN |
$160.38
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$280.50 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.14
|
| Rate for Payer: Blue Shield of California Commercial |
$243.54
|
| Rate for Payer: Blue Shield of California EPN |
$160.38
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$212.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC FOOT COMPLETE
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$507.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.88
|
| Rate for Payer: Blue Shield of California Commercial |
$473.08
|
| Rate for Payer: Blue Shield of California EPN |
$312.29
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FOOT COMPLETE
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$515.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$478.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.30
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$72.41
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.30
|
| Rate for Payer: Blue Shield of California Commercial |
$109.96
|
| Rate for Payer: Blue Shield of California EPN |
$72.41
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,211.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,543.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,016.23
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$558.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,463.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
