|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,243.04 |
| Max. Negotiated Rate |
$7,944.10 |
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,657.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,187.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,738.42
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,229.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,542.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$6,074.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,243.04 |
| Max. Negotiated Rate |
$7,944.10 |
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,657.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,187.07
|
| Rate for Payer: Blue Shield of California Commercial |
$4,738.42
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,229.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,243.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,542.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$3,708.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,369.44 |
| Max. Negotiated Rate |
$4,850.10 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,453.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,387.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.94
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,863.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$3,708.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,369.44 |
| Max. Negotiated Rate |
$4,850.10 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,453.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,387.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,892.94
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,863.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,369.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,564.80
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,685.60 |
| Max. Negotiated Rate |
$9,511.50 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,773.31
|
| Rate for Payer: Blue Shield of California Commercial |
$8,605.11
|
| Rate for Payer: Blue Shield of California Commercial |
$5,673.33
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,126.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,685.60 |
| Max. Negotiated Rate |
$9,511.50 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,773.31
|
| Rate for Payer: Blue Shield of California Commercial |
$8,605.11
|
| Rate for Payer: Blue Shield of California Commercial |
$5,673.33
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,126.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.20
|
| Rate for Payer: Blue Shield of California Commercial |
$260.69
|
| Rate for Payer: Blue Shield of California Commercial |
$171.87
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.20
|
| Rate for Payer: Blue Shield of California Commercial |
$260.69
|
| Rate for Payer: Blue Shield of California Commercial |
$171.87
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cigna of CA HMO |
$407.68
|
| Rate for Payer: Cigna of CA PPO |
$471.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$445.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$404.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.50
|
| Rate for Payer: United Healthcare All Other HMO |
$318.50
|
| Rate for Payer: United Healthcare HMO Rider |
$318.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$445.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Senior |
$254.80
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$404.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$375.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$531.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$481.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$447.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$170.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.63
|
| Rate for Payer: Blue Shield of California Commercial |
$319.54
|
| Rate for Payer: Blue Shield of California Commercial |
$484.24
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO |
$485.76
|
| Rate for Payer: Cigna of CA PPO |
$561.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$531.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$481.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$302.40
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$446.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.65
|
| Rate for Payer: Blue Shield of California Commercial |
$318.28
|
| Rate for Payer: Blue Shield of California Commercial |
$482.33
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna of CA HMO |
$483.84
|
| Rate for Payer: Cigna of CA PPO |
$559.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$529.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$480.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$163.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$163.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$163.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$163.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
