|
HC HERMETIC CATH DRAIN LUMBAR KIT
|
Facility
|
IP
|
$632.91
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$126.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: Cigna of CA HMO |
$443.04
|
| Rate for Payer: Cigna of CA PPO |
$443.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.16
|
| Rate for Payer: EPIC Health Plan Senior |
$253.16
|
| Rate for Payer: Galaxy Health WC |
$537.97
|
| Rate for Payer: Global Benefits Group Commercial |
$379.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.90
|
| Rate for Payer: Multiplan Commercial |
$506.33
|
| Rate for Payer: Networks By Design Commercial |
$316.45
|
| Rate for Payer: Prime Health Services Commercial |
$537.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.53
|
| Rate for Payer: United Healthcare All Other HMO |
$231.20
|
| Rate for Payer: United Healthcare HMO Rider |
$226.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.28
|
|
|
HC HERMETIC CATH DRAIN LUMBAR KIT
|
Facility
|
OP
|
$632.91
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698826
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.58 |
| Max. Negotiated Rate |
$537.97 |
| Rate for Payer: Adventist Health Commercial |
$126.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$537.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.58
|
| Rate for Payer: Blue Shield of California Commercial |
$467.09
|
| Rate for Payer: Blue Shield of California EPN |
$307.59
|
| Rate for Payer: Cash Price |
$284.81
|
| Rate for Payer: Cigna of CA HMO |
$443.04
|
| Rate for Payer: Cigna of CA PPO |
$443.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$537.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$537.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$537.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.16
|
| Rate for Payer: EPIC Health Plan Senior |
$253.16
|
| Rate for Payer: Galaxy Health WC |
$537.97
|
| Rate for Payer: Global Benefits Group Commercial |
$379.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$506.33
|
| Rate for Payer: Networks By Design Commercial |
$316.45
|
| Rate for Payer: Prime Health Services Commercial |
$537.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.53
|
| Rate for Payer: United Healthcare All Other HMO |
$231.20
|
| Rate for Payer: United Healthcare HMO Rider |
$226.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$537.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$537.97
|
| Rate for Payer: Vantage Medical Group Senior |
$537.97
|
|
|
HC HERMETIC VENTRCLR CATH SET 6MM
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC HERMETIC VENTRCLR CATH SET 6MM
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC HERNIA REDUCTION
|
Facility
|
IP
|
$8,123.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,624.60 |
| Max. Negotiated Rate |
$6,904.55 |
| Rate for Payer: Adventist Health Commercial |
$1,624.60
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,249.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,249.20
|
| Rate for Payer: Galaxy Health WC |
$6,904.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,873.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,094.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,028.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,949.52
|
| Rate for Payer: Multiplan Commercial |
$6,498.40
|
| Rate for Payer: Networks By Design Commercial |
$5,279.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,904.55
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$8,123.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.26 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,624.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,988.33
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: Cigna of CA HMO |
$5,198.72
|
| Rate for Payer: Cigna of CA PPO |
$6,011.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$6,904.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,873.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,949.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$6,498.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$5,279.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,904.55
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,873.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC HERNIA REDUCTION
|
Facility
|
OP
|
$8,123.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$6,904.55 |
| Rate for Payer: Adventist Health Commercial |
$1,624.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: Cigna of CA HMO |
$5,198.72
|
| Rate for Payer: Cigna of CA PPO |
$6,011.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$6,904.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,873.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,949.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$6,498.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$5,279.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,904.55
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,873.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,061.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,061.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,061.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,061.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC HERNIA REDUCTION
|
Facility
|
IP
|
$8,123.00
|
|
|
Service Code
|
CPT 49999
|
| Hospital Charge Code |
909020037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,624.60 |
| Max. Negotiated Rate |
$6,904.55 |
| Rate for Payer: Adventist Health Commercial |
$1,624.60
|
| Rate for Payer: Cash Price |
$3,655.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,249.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,249.20
|
| Rate for Payer: Galaxy Health WC |
$6,904.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,873.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,094.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,028.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,949.52
|
| Rate for Payer: Multiplan Commercial |
$6,498.40
|
| Rate for Payer: Networks By Design Commercial |
$5,279.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,904.55
|
|
|
HC HERPES SIMPLEX TYPE 1
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$130.27 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.27
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.81
|
| Rate for Payer: EPIC Health Plan Senior |
$13.19
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.67
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.68
|
| Rate for Payer: United Healthcare All Other HMO |
$10.68
|
| Rate for Payer: United Healthcare HMO Rider |
$10.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.51
|
| Rate for Payer: Vantage Medical Group Senior |
$13.19
|
|
|
HC HERPES SIMPLEX TYPE 1
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
900913660
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$191.05 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.05
|
| Rate for Payer: Blue Shield of California Commercial |
$65.56
|
| Rate for Payer: Blue Shield of California EPN |
$43.32
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.12
|
| Rate for Payer: EPIC Health Plan Senior |
$19.35
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.93
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.68
|
| Rate for Payer: United Healthcare All Other HMO |
$15.68
|
| Rate for Payer: United Healthcare HMO Rider |
$15.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.68
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.29
|
| Rate for Payer: Vantage Medical Group Senior |
$19.35
|
|
|
HC HERPES SIMPLEX TYPE 2
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
900913661
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$113.90 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.42
|
| Rate for Payer: United Healthcare All Other HMO |
$50.05
|
| Rate for Payer: United Healthcare HMO Rider |
$48.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.87
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
915353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.42
|
| Rate for Payer: United Healthcare All Other HMO |
$50.05
|
| Rate for Payer: United Healthcare HMO Rider |
$48.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.87
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
915353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.35
|
| Rate for Payer: Blue Shield of California Commercial |
$101.11
|
| Rate for Payer: Blue Shield of California EPN |
$66.58
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.42
|
| Rate for Payer: United Healthcare All Other HMO |
$50.05
|
| Rate for Payer: United Healthcare HMO Rider |
$48.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC HFO,NO JOINT,PREFABRICATED
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
905353923
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.88 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$56.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.35
|
| Rate for Payer: Blue Shield of California Commercial |
$101.11
|
| Rate for Payer: Blue Shield of California EPN |
$66.58
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$95.90
|
| Rate for Payer: Cigna of CA PPO |
$95.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$84.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$68.50
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.42
|
| Rate for Payer: United Healthcare All Other HMO |
$50.05
|
| Rate for Payer: United Healthcare HMO Rider |
$48.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
915353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.02
|
| Rate for Payer: Blue Shield of California Commercial |
$354.24
|
| Rate for Payer: Blue Shield of California EPN |
$233.28
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$308.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
915353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
905353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
|
|
HC HFO W/JOINT(S) CF
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
905353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.02
|
| Rate for Payer: Blue Shield of California Commercial |
$354.24
|
| Rate for Payer: Blue Shield of California EPN |
$233.28
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$308.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
HC HFO WO JOINT PF
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC HFO WO JOINT PF
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$224.40 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.91
|
| Rate for Payer: Blue Shield of California Commercial |
$194.83
|
| Rate for Payer: Blue Shield of California EPN |
$128.30
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.58
|
| Rate for Payer: Blue Shield of California Commercial |
$298.89
|
| Rate for Payer: Blue Shield of California EPN |
$196.83
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
915353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.58
|
| Rate for Payer: Blue Shield of California Commercial |
$298.89
|
| Rate for Payer: Blue Shield of California EPN |
$196.83
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
