|
HC LEAD REPOSITION A OR V
|
Facility
|
OP
|
$5,107.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cigna of CA HMO |
$3,268.48
|
| Rate for Payer: Adventist Health Commercial |
$1,021.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$2,298.15
|
| Rate for Payer: Cash Price |
$2,298.15
|
| Rate for Payer: Cash Price |
$2,298.15
|
| Rate for Payer: Cigna of CA PPO |
$3,779.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,574.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$4,340.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,242.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,085.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,319.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,340.95
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,064.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,553.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC LEAD REPOSITION A OR V
|
Facility
|
IP
|
$5,107.00
|
|
|
Service Code
|
CPT 33215
|
| Hospital Charge Code |
906812213
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,021.40 |
| Max. Negotiated Rate |
$4,340.95 |
| Rate for Payer: Adventist Health Commercial |
$1,021.40
|
| Rate for Payer: Cash Price |
$2,298.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,574.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,042.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,042.80
|
| Rate for Payer: Galaxy Health WC |
$4,340.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,242.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,013.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,225.68
|
| Rate for Payer: Multiplan Commercial |
$4,085.60
|
| Rate for Payer: Networks By Design Commercial |
$3,319.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,340.95
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
OP
|
$5,376.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$451.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cigna of CA HMO |
$3,440.64
|
| Rate for Payer: Cigna of CA PPO |
$3,978.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$4,569.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$451.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,413.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$510.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,300.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,494.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,569.60
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,225.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC LEAD REPOSITION CS
|
Facility
|
IP
|
$5,376.00
|
|
|
Service Code
|
CPT 33226
|
| Hospital Charge Code |
906812216
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,075.20 |
| Max. Negotiated Rate |
$4,569.60 |
| Rate for Payer: Adventist Health Commercial |
$1,075.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,150.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,150.40
|
| Rate for Payer: Galaxy Health WC |
$4,569.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,225.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,413.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,171.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.24
|
| Rate for Payer: Multiplan Commercial |
$4,300.80
|
| Rate for Payer: Networks By Design Commercial |
$3,494.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,569.60
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.72
|
| Rate for Payer: Blue Shield of California Commercial |
$191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$126.24
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.72
|
| Rate for Payer: Blue Shield of California Commercial |
$191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$126.24
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
IP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$117.25 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.11
|
| Rate for Payer: Multiplan Commercial |
$110.35
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
OP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$117.25 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.52
|
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Cigna of CA HMO |
$88.28
|
| Rate for Payer: Cigna of CA PPO |
$102.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.56
|
| Rate for Payer: Multiplan Commercial |
$110.35
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.97
|
| Rate for Payer: United Healthcare All Other HMO |
$68.97
|
| Rate for Payer: United Healthcare HMO Rider |
$68.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.25
|
| Rate for Payer: Vantage Medical Group Senior |
$117.25
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$80,419.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,140.22 |
| Max. Negotiated Rate |
$68,356.15 |
| Rate for Payer: Adventist Health Commercial |
$16,083.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,230.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60,314.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,472.51
|
| Rate for Payer: Blue Shield of California Commercial |
$5,596.61
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Cigna of CA HMO |
$51,468.16
|
| Rate for Payer: Cigna of CA PPO |
$59,510.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$68,356.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68,356.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56,293.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$32,167.60
|
| Rate for Payer: Galaxy Health WC |
$68,356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$48,251.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,140.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51,066.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,289.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,447.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,293.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56,293.30
|
| Rate for Payer: Multiplan Commercial |
$64,335.20
|
| Rate for Payer: Networks By Design Commercial |
$52,272.35
|
| Rate for Payer: Prime Health Services Commercial |
$68,356.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$40,209.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68,356.15
|
| Rate for Payer: Vantage Medical Group Senior |
$68,356.15
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
IP
|
$80,419.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,083.80 |
| Max. Negotiated Rate |
$68,356.15 |
| Rate for Payer: Adventist Health Commercial |
$16,083.80
|
| Rate for Payer: Cash Price |
$36,188.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56,293.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$32,167.60
|
| Rate for Payer: Galaxy Health WC |
$68,356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$48,251.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51,066.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47,447.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,300.56
|
| Rate for Payer: Multiplan Commercial |
$64,335.20
|
| Rate for Payer: Networks By Design Commercial |
$52,272.35
|
| Rate for Payer: Prime Health Services Commercial |
$68,356.15
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$12,209.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,441.80 |
| Max. Negotiated Rate |
$10,377.65 |
| Rate for Payer: Adventist Health Commercial |
$2,441.80
|
| Rate for Payer: Cash Price |
$5,494.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,546.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,883.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,883.60
|
| Rate for Payer: Galaxy Health WC |
$10,377.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,325.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,752.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,203.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,930.16
|
| Rate for Payer: Multiplan Commercial |
$9,767.20
|
| Rate for Payer: Networks By Design Commercial |
$7,935.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,377.65
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$12,209.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$277.44 |
| Max. Negotiated Rate |
$16,261.00 |
| Rate for Payer: Adventist Health Commercial |
$2,441.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,377.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,714.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,156.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$5,494.05
|
| Rate for Payer: Cash Price |
$5,494.05
|
| Rate for Payer: Cash Price |
$5,494.05
|
| Rate for Payer: Cigna of CA HMO |
$7,935.85
|
| Rate for Payer: Cigna of CA PPO |
$9,034.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,377.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,377.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,377.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,546.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,883.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,883.60
|
| Rate for Payer: Galaxy Health WC |
$10,377.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,325.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,752.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,203.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,930.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,546.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,546.30
|
| Rate for Payer: Multiplan Commercial |
$9,767.20
|
| Rate for Payer: Networks By Design Commercial |
$7,935.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,377.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,325.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,325.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,104.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,377.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,377.65
|
| Rate for Payer: Vantage Medical Group Senior |
$10,377.65
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$11,095.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,219.00 |
| Max. Negotiated Rate |
$9,430.75 |
| Rate for Payer: Adventist Health Commercial |
$2,219.00
|
| Rate for Payer: Cash Price |
$4,992.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,438.00
|
| Rate for Payer: Galaxy Health WC |
$9,430.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,045.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,546.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,662.80
|
| Rate for Payer: Multiplan Commercial |
$8,876.00
|
| Rate for Payer: Networks By Design Commercial |
$7,211.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,430.75
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$11,095.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,281.60 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,219.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Cash Price |
$4,992.75
|
| Rate for Payer: Cash Price |
$4,992.75
|
| Rate for Payer: Cash Price |
$4,992.75
|
| Rate for Payer: Cigna of CA HMO |
$7,211.75
|
| Rate for Payer: Cigna of CA PPO |
$8,210.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$9,430.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,281.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,045.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,662.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$8,876.00
|
| Rate for Payer: Networks By Design Commercial |
$7,211.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,430.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$583.95
|
| Rate for Payer: Adventist Health Commercial |
$137.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Cigna of CA HMO |
$439.68
|
| Rate for Payer: Cigna of CA PPO |
$508.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$480.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: Global Benefits Group Commercial |
$412.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$436.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$446.55
|
| Rate for Payer: Prime Health Services Commercial |
$583.95
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$412.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$343.50
|
| Rate for Payer: United Healthcare All Other HMO |
$343.50
|
| Rate for Payer: United Healthcare HMO Rider |
$343.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$583.95 |
| Rate for Payer: Adventist Health Commercial |
$137.40
|
| Rate for Payer: Cash Price |
$309.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$480.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.80
|
| Rate for Payer: EPIC Health Plan Senior |
$274.80
|
| Rate for Payer: Galaxy Health WC |
$583.95
|
| Rate for Payer: Global Benefits Group Commercial |
$412.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$436.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$405.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.88
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: Networks By Design Commercial |
$446.55
|
| Rate for Payer: Prime Health Services Commercial |
$583.95
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$3,192.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,178.64 |
| Max. Negotiated Rate |
$4,174.35 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,972.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,776.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,489.88
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,123.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,437.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$3,192.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,178.64 |
| Max. Negotiated Rate |
$4,174.35 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,972.63
|
| Rate for Payer: Blue Shield of California Commercial |
$3,776.56
|
| Rate for Payer: Blue Shield of California Commercial |
$2,489.88
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,123.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,437.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,146.44
|
| Rate for Payer: Blue Shield of California Commercial |
$960.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,456.49
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$950.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,146.44
|
| Rate for Payer: Blue Shield of California Commercial |
$960.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,456.49
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$950.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$1,231.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
