|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.76
|
| Rate for Payer: Blue Shield of California Commercial |
$221.40
|
| Rate for Payer: Blue Shield of California EPN |
$145.80
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$141.49 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.19
|
| Rate for Payer: Blue Shield of California Commercial |
$99.63
|
| Rate for Payer: Blue Shield of California EPN |
$65.61
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.06
|
| Rate for Payer: Blue Shield of California Commercial |
$331.36
|
| Rate for Payer: Blue Shield of California EPN |
$218.21
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.06
|
| Rate for Payer: Blue Shield of California Commercial |
$331.36
|
| Rate for Payer: Blue Shield of California EPN |
$218.21
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cash Price |
$246.95
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.49
|
| Rate for Payer: Blue Shield of California Commercial |
$195.57
|
| Rate for Payer: Blue Shield of California EPN |
$128.79
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
915351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$974.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.92
|
| Rate for Payer: Multiplan Commercial |
$2,046.40
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$511.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$974.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.92
|
| Rate for Payer: Multiplan Commercial |
$2,046.40
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$613.92 |
| Max. Negotiated Rate |
$2,174.30 |
| Rate for Payer: Adventist Health Commercial |
$1,048.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,406.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,918.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,887.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,243.19
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,174.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,604.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,790.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,790.60
|
| Rate for Payer: Multiplan Commercial |
$2,046.40
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,534.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,174.30
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
915351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$613.92 |
| Max. Negotiated Rate |
$2,174.30 |
| Rate for Payer: Adventist Health Commercial |
$1,048.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,406.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,918.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,481.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,887.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,243.19
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,174.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,604.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$613.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,790.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,790.60
|
| Rate for Payer: Multiplan Commercial |
$2,046.40
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,534.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,174.30
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905361686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$797.04 |
| Max. Negotiated Rate |
$2,822.85 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,923.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,450.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,614.01
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,100.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,324.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,265.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.04
|
| Rate for Payer: Multiplan Commercial |
$2,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$797.04 |
| Max. Negotiated Rate |
$2,822.85 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,923.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,450.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,614.01
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,100.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,324.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905361686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,265.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.04
|
| Rate for Payer: Multiplan Commercial |
$2,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
915351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$797.04 |
| Max. Negotiated Rate |
$2,822.85 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,923.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,450.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,614.01
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,100.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,324.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
915351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,265.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.04
|
| Rate for Payer: Multiplan Commercial |
$2,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
OP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
905351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$712.08 |
| Max. Negotiated Rate |
$2,521.95 |
| Rate for Payer: Adventist Health Commercial |
$1,216.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,631.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,225.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,718.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,189.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,441.96
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,521.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,521.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,310.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,482.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,836.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,076.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,076.90
|
| Rate for Payer: Multiplan Commercial |
$2,373.60
|
| Rate for Payer: Networks By Design Commercial |
$1,483.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,780.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,521.95
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
OP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
915351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$712.08 |
| Max. Negotiated Rate |
$2,521.95 |
| Rate for Payer: Adventist Health Commercial |
$1,216.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,631.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,225.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,718.49
|
| Rate for Payer: Blue Shield of California Commercial |
$2,189.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,441.96
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,521.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,521.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,310.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,482.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,836.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,076.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,076.90
|
| Rate for Payer: Multiplan Commercial |
$2,373.60
|
| Rate for Payer: Networks By Design Commercial |
$1,483.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,780.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,521.95
|
|
