|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$6,265.15 |
| Rate for Payer: Adventist Health Commercial |
$380.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,248.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$881.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,265.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,165.25
|
| Rate for Payer: Blue Shield of California EPN |
$769.22
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cigna of CA HMO |
$1,218.56
|
| Rate for Payer: Cigna of CA PPO |
$1,408.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$881.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,190.09
|
| Rate for Payer: EPIC Health Plan Senior |
$881.55
|
| Rate for Payer: Galaxy Health WC |
$1,618.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,445.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,361.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$881.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,269.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,540.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$881.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$456.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,110.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,181.28
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: Networks By Design Commercial |
$1,237.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.00
|
| Rate for Payer: United Healthcare All Other HMO |
$952.00
|
| Rate for Payer: United Healthcare HMO Rider |
$952.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$881.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.71
|
| Rate for Payer: Vantage Medical Group Senior |
$881.55
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,093.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,468.08 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13,739.35
|
| Rate for Payer: Blue Shield of California EPN |
$9,047.86
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,625.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,031.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,093.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,468.08 |
| Max. Negotiated Rate |
$15,824.45 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13,739.35
|
| Rate for Payer: Blue Shield of California EPN |
$9,047.86
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,625.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,468.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,031.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$14,893.60
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HEAD ECHO
|
Facility
|
IP
|
$1,859.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$371.80 |
| Max. Negotiated Rate |
$1,580.15 |
| Rate for Payer: Adventist Health Commercial |
$371.80
|
| Rate for Payer: Cash Price |
$836.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$743.60
|
| Rate for Payer: EPIC Health Plan Senior |
$743.60
|
| Rate for Payer: Galaxy Health WC |
$1,580.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$708.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,150.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.16
|
| Rate for Payer: Multiplan Commercial |
$1,487.20
|
| Rate for Payer: Networks By Design Commercial |
$1,208.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,580.15
|
|
|
HC HEAD ECHO
|
Facility
|
OP
|
$1,859.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$104.55 |
| Max. Negotiated Rate |
$1,580.15 |
| Rate for Payer: Adventist Health Commercial |
$371.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,219.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,141.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,137.71
|
| Rate for Payer: Blue Shield of California EPN |
$751.04
|
| Rate for Payer: Cash Price |
$836.55
|
| Rate for Payer: Cash Price |
$836.55
|
| Rate for Payer: Cigna of CA HMO |
$1,189.76
|
| Rate for Payer: Cigna of CA PPO |
$1,375.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,580.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,115.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,239.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,487.20
|
| Rate for Payer: Networks By Design Commercial |
$1,208.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,580.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,115.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,115.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC HEAD SCARVES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
|
HC HEAD SCARVES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
|
HC HEAD SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.38
|
| Rate for Payer: Blue Shield of California Commercial |
$36.16
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC HEAD SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.38
|
| Rate for Payer: Blue Shield of California Commercial |
$36.16
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
OP
|
$10,044.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$15,561.00 |
| Rate for Payer: Adventist Health Commercial |
$2,008.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,537.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,524.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,533.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: Cigna of CA HMO |
$6,528.60
|
| Rate for Payer: Cigna of CA PPO |
$7,432.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,537.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,537.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,537.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,017.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,017.60
|
| Rate for Payer: Galaxy Health WC |
$8,537.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,026.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,699.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,826.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,217.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,030.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,030.80
|
| Rate for Payer: Multiplan Commercial |
$8,035.20
|
| Rate for Payer: Networks By Design Commercial |
$6,528.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,537.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,026.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,026.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,022.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,022.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,022.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,022.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,537.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,537.40
|
| Rate for Payer: Vantage Medical Group Senior |
$8,537.40
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
IP
|
$10,044.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,008.80 |
| Max. Negotiated Rate |
$8,537.40 |
| Rate for Payer: Adventist Health Commercial |
$2,008.80
|
| Rate for Payer: Cash Price |
$4,519.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,017.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,017.60
|
| Rate for Payer: Galaxy Health WC |
$8,537.40
|
| Rate for Payer: Global Benefits Group Commercial |
$6,026.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,699.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,826.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,217.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,410.56
|
| Rate for Payer: Multiplan Commercial |
$8,035.20
|
| Rate for Payer: Networks By Design Commercial |
$6,528.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,537.40
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
OP
|
$8,035.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,607.00 |
| Max. Negotiated Rate |
$9,339.00 |
| Rate for Payer: Adventist Health Commercial |
$1,607.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,419.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,026.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: Cigna of CA HMO |
$5,222.75
|
| Rate for Payer: Cigna of CA PPO |
$5,945.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,829.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,829.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,214.00
|
| Rate for Payer: Galaxy Health WC |
$6,829.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,821.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,359.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,061.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,973.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,624.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,624.50
|
| Rate for Payer: Multiplan Commercial |
$6,428.00
|
| Rate for Payer: Networks By Design Commercial |
$5,222.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,829.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,821.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,821.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,017.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,017.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,017.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,017.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,829.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,829.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,829.75
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
IP
|
$8,035.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,607.00 |
| Max. Negotiated Rate |
$6,829.75 |
| Rate for Payer: Adventist Health Commercial |
$1,607.00
|
| Rate for Payer: Cash Price |
$3,615.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,214.00
|
| Rate for Payer: Galaxy Health WC |
$6,829.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,821.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,359.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,061.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,973.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,928.40
|
| Rate for Payer: Multiplan Commercial |
$6,428.00
|
| Rate for Payer: Networks By Design Commercial |
$5,222.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,829.75
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
IP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$514.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$514.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,716.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$980.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,592.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.52
|
| Rate for Payer: Multiplan Commercial |
$2,058.40
|
| Rate for Payer: Networks By Design Commercial |
$1,286.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
OP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$617.52 |
| Max. Negotiated Rate |
$2,187.05 |
| Rate for Payer: Adventist Health Commercial |
$1,054.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,415.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,929.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,490.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,898.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,250.48
|
| Rate for Payer: Cash Price |
$1,157.85
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,187.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,187.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,716.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$980.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,592.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$617.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,801.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,801.10
|
| Rate for Payer: Multiplan Commercial |
$2,058.40
|
| Rate for Payer: Networks By Design Commercial |
$1,286.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,543.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,543.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,187.05
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.88
|
| Rate for Payer: Blue Shield of California Commercial |
$110.70
|
| Rate for Payer: Blue Shield of California EPN |
$72.90
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
915353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.88
|
| Rate for Payer: Blue Shield of California Commercial |
$110.70
|
| Rate for Payer: Blue Shield of California EPN |
$72.90
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
915353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
915353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.96
|
| Rate for Payer: Blue Shield of California Commercial |
$185.98
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
915353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.68 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.96
|
| Rate for Payer: Blue Shield of California Commercial |
$185.98
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
|
