|
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 |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| 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
|
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 |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| 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 |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| 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 |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| 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
|
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 |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| 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 |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| 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
|
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 |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| 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 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 |
$1,335.15
|
| Rate for Payer: Cash Price |
$1,335.15
|
| 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
|
IP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
905351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$593.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,130.43
|
| 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: 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: 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
|
|
|
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 |
$1,335.15
|
| Rate for Payer: Cash Price |
$1,335.15
|
| 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
|
IP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
915351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$593.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Cash Price |
$1,335.15
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,130.43
|
| 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: 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: 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
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
915351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.54
|
| Rate for Payer: Blue Shield of California Commercial |
$512.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.77
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
905351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
905351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.54
|
| Rate for Payer: Blue Shield of California Commercial |
$512.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.77
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$280.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
915351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
905351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Adventist Health Commercial |
$113.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.86
|
| Rate for Payer: Blue Shield of California Commercial |
$203.69
|
| Rate for Payer: Blue Shield of California EPN |
$134.14
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
915351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Adventist Health Commercial |
$113.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.86
|
| Rate for Payer: Blue Shield of California Commercial |
$203.69
|
| Rate for Payer: Blue Shield of California EPN |
$134.14
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$122.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
915351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
905351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
915351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.36
|
| Rate for Payer: Blue Shield of California Commercial |
$143.17
|
| Rate for Payer: Blue Shield of California EPN |
$94.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
905351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.36
|
| Rate for Payer: Blue Shield of California Commercial |
$143.17
|
| Rate for Payer: Blue Shield of California EPN |
$94.28
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
905351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
|
HC HO ABDUCTION VAN ROSEN
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L1630
|
| Hospital Charge Code |
915351630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
915351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC HO BILAT THIGH CUFF ADJUSTABLE
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L1652
|
| Hospital Charge Code |
905351652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$324.35
|
| Rate for Payer: Blue Shield of California Commercial |
$413.28
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$376.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
