|
HC HLTH BHV ASSMT/REASSMT
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT 96156
|
| Hospital Charge Code |
902506156
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$138.20 |
| Max. Negotiated Rate |
$587.35 |
| Rate for Payer: Adventist Health Commercial |
$138.20
|
| Rate for Payer: Cash Price |
$310.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$483.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.40
|
| Rate for Payer: EPIC Health Plan Senior |
$276.40
|
| Rate for Payer: Galaxy Health WC |
$587.35
|
| Rate for Payer: Global Benefits Group Commercial |
$414.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$438.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$407.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: Networks By Design Commercial |
$449.15
|
| Rate for Payer: Prime Health Services Commercial |
$587.35
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$420.12 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.69
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC HLTH BHV INTV FMLY W/PT 30 MIN
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
902506167
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$67.15 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC HLTH BHV INTV FMY WO PT 30 MIN
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 96170
|
| Hospital Charge Code |
902506170
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$149.60 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
|
|
HC HLTH BHV INTV FMY WO PT 30 MIN
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 96170
|
| Hospital Charge Code |
902506170
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$509.04 |
| Rate for Payer: Adventist Health Commercial |
$35.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$509.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.94
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna of CA HMO |
$112.64
|
| Rate for Payer: Cigna of CA PPO |
$130.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Senior |
$70.40
|
| Rate for Payer: Galaxy Health WC |
$149.60
|
| Rate for Payer: Global Benefits Group Commercial |
$105.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$118.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.20
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: Networks By Design Commercial |
$114.40
|
| Rate for Payer: Prime Health Services Commercial |
$149.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Vantage Medical Group Senior |
$149.60
|
|
|
HC HLTH BHVR INTVN FMLY W PT; INITIAL 30 MIN
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
908603072
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC HLTH BHVR INTVN FMLY W PT; INITIAL 30 MIN
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 96167
|
| Hospital Charge Code |
908603072
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$420.12 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$420.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.67
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
915351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Adventist Health Commercial |
$72.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.14
|
| Rate for Payer: Blue Shield of California Commercial |
$89.74
|
| Rate for Payer: Blue Shield of California Commercial |
$136.11
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.90
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.45
|
| Rate for Payer: Vantage Medical Group Senior |
$150.45
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.30 |
| Max. Negotiated Rate |
$150.45 |
| Rate for Payer: Adventist Health Commercial |
$72.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.14
|
| Rate for Payer: Blue Shield of California Commercial |
$89.74
|
| Rate for Payer: Blue Shield of California Commercial |
$136.11
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.90
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.45
|
| Rate for Payer: Vantage Medical Group Senior |
$150.45
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
915351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.48
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$255.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$181.59
|
| Rate for Payer: Blue Shield of California Commercial |
$230.70
|
| Rate for Payer: Blue Shield of California Commercial |
$152.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$141.49 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.72
|
| Rate for Payer: Blue Shield of California Commercial |
$68.44
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.78
|
| Rate for Payer: Blue Shield of California Commercial |
$345.28
|
| Rate for Payer: Blue Shield of California Commercial |
$227.64
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$381.65 |
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$271.78
|
| Rate for Payer: Blue Shield of California Commercial |
$345.28
|
| Rate for Payer: Blue Shield of California Commercial |
$227.64
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$259.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$314.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$203.78
|
| Rate for Payer: Blue Shield of California Commercial |
$134.35
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.40
|
| Rate for Payer: Blue Shield of California Commercial |
$203.78
|
| Rate for Payer: Blue Shield of California Commercial |
$134.35
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
