|
HC HALO ADDITION MRI COMPATIBLE
|
Facility
|
OP
|
$2,933.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$703.92 |
| Max. Negotiated Rate |
$2,493.05 |
| Rate for Payer: Adventist Health Commercial |
$1,202.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,613.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,199.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,698.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,164.55
|
| Rate for Payer: Blue Shield of California EPN |
$1,425.44
|
| Rate for Payer: Cash Price |
$1,613.15
|
| Rate for Payer: Cash Price |
$1,613.15
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,493.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,493.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,173.20
|
| Rate for Payer: Galaxy Health WC |
$2,493.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,759.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,815.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,053.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,053.10
|
| Rate for Payer: Multiplan Commercial |
$2,346.40
|
| Rate for Payer: Networks By Design Commercial |
$1,466.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,759.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,048.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$960.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,493.05
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,878.50 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,280.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,630.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,074.06
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,547.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$530.40 |
| Max. Negotiated Rate |
$1,878.50 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,280.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,630.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,074.06
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,547.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,243.04 |
| Max. Negotiated Rate |
$7,944.10 |
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,413.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,897.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,542.16
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,229.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,542.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,243.04 |
| Max. Negotiated Rate |
$7,944.10 |
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,413.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,897.35
|
| Rate for Payer: Blue Shield of California EPN |
$4,542.16
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,229.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,542.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,369.44 |
| Max. Negotiated Rate |
$4,850.10 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,304.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4,211.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,773.12
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,863.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,369.44 |
| Max. Negotiated Rate |
$4,850.10 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,304.92
|
| Rate for Payer: Blue Shield of California Commercial |
$4,211.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,773.12
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,863.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,685.60 |
| Max. Negotiated Rate |
$9,511.50 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,481.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,258.22
|
| Rate for Payer: Blue Shield of California EPN |
$5,438.34
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,126.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,685.60 |
| Max. Negotiated Rate |
$9,511.50 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,481.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,258.22
|
| Rate for Payer: Blue Shield of California EPN |
$5,438.34
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,126.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.35
|
| Rate for Payer: Blue Shield of California Commercial |
$250.18
|
| Rate for Payer: Blue Shield of California EPN |
$164.75
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.35
|
| Rate for Payer: Blue Shield of California Commercial |
$250.18
|
| Rate for Payer: Blue Shield of California EPN |
$164.75
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$350.35
|
| Rate for Payer: Cash Price |
$350.35
|
| Rate for Payer: Cash Price |
$350.35
|
| Rate for Payer: Cigna of CA HMO |
$407.68
|
| Rate for Payer: Cigna of CA PPO |
$471.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.50
|
| Rate for Payer: United Healthcare All Other HMO |
$318.50
|
| Rate for Payer: United Healthcare HMO Rider |
$318.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Cash Price |
$350.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Senior |
$254.80
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Cash Price |
$417.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.83
|
| 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 |
$464.51
|
| Rate for Payer: Blue Shield of California EPN |
$306.64
|
| Rate for Payer: Cash Price |
$417.45
|
| Rate for Payer: Cash Price |
$417.45
|
| Rate for Payer: Cigna of CA HMO |
$485.76
|
| Rate for Payer: Cigna of CA PPO |
$561.66
|
| 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 |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| 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 |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.40
|
| 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
|
|
