|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,373.28 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,463.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,400.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,901.05
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,728.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,005.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
905355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
IP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,144.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,144.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$3,719.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
|
|
HC MULTIAXIAL ANKLE W DORSIFLEX
|
Facility
|
OP
|
$5,722.00
|
|
|
Service Code
|
CPT L5968
|
| Hospital Charge Code |
915355968
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,373.28 |
| Max. Negotiated Rate |
$4,863.70 |
| Rate for Payer: Adventist Health Commercial |
$2,346.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,147.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,291.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,463.53
|
| Rate for Payer: Blue Shield of California Commercial |
$4,400.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,901.05
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna of CA HMO |
$4,005.40
|
| Rate for Payer: Cigna of CA PPO |
$4,005.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,863.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,863.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,005.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,288.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,288.80
|
| Rate for Payer: Galaxy Health WC |
$4,863.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,433.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,728.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,633.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,085.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,375.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,373.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,005.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,005.40
|
| Rate for Payer: Multiplan Commercial |
$4,577.60
|
| Rate for Payer: Networks By Design Commercial |
$2,861.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,863.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,433.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,433.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,147.47
|
| Rate for Payer: United Healthcare All Other HMO |
$2,090.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,045.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,873.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,863.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,863.70
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.87 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.91
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Cigna of CA HMO |
$87.68
|
| Rate for Payer: Cigna of CA PPO |
$101.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$95.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$95.90
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.45
|
| Rate for Payer: Vantage Medical Group Senior |
$116.45
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$27.40 |
| Max. Negotiated Rate |
$116.45 |
| Rate for Payer: Adventist Health Commercial |
$27.40
|
| Rate for Payer: Cash Price |
$61.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.80
|
| Rate for Payer: EPIC Health Plan Senior |
$54.80
|
| Rate for Payer: Galaxy Health WC |
$116.45
|
| Rate for Payer: Global Benefits Group Commercial |
$82.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.88
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Networks By Design Commercial |
$89.05
|
| Rate for Payer: Prime Health Services Commercial |
$116.45
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
915365511
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.11
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.18
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.18
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$218.40
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,511.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC MULTIFETAL PREG REDUCTION MPR
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,511.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$587.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.68
|
| Rate for Payer: EPIC Health Plan Senior |
$431.12
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$642.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$391.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$548.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.19
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$391.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$587.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.12
|
| Rate for Payer: Vantage Medical Group Senior |
$391.93
|
|
|
HC MULTIFETAL PREG REDUCTION MPR ADDL FETUS
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59866
|
| Hospital Charge Code |
910400095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
OP
|
$1,849.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$369.80 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$369.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,571.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,016.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,386.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,186.50
|
| Rate for Payer: Cash Price |
$832.05
|
| Rate for Payer: Cash Price |
$832.05
|
| Rate for Payer: Cigna of CA HMO |
$1,183.36
|
| Rate for Payer: Cigna of CA PPO |
$1,368.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,571.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,571.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,571.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,294.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$739.60
|
| Rate for Payer: EPIC Health Plan Senior |
$739.60
|
| Rate for Payer: Galaxy Health WC |
$1,571.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,109.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$671.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,090.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,294.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,294.30
|
| Rate for Payer: Multiplan Commercial |
$1,479.20
|
| Rate for Payer: Networks By Design Commercial |
$1,201.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,571.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,109.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,109.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$924.50
|
| Rate for Payer: United Healthcare All Other HMO |
$924.50
|
| Rate for Payer: United Healthcare HMO Rider |
$924.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$924.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,571.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,571.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,571.65
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
IP
|
$1,849.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$369.80 |
| Max. Negotiated Rate |
$1,571.65 |
| Rate for Payer: Adventist Health Commercial |
$369.80
|
| Rate for Payer: Cash Price |
$832.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,294.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$739.60
|
| Rate for Payer: EPIC Health Plan Senior |
$739.60
|
| Rate for Payer: Galaxy Health WC |
$1,571.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,109.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,174.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,090.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$443.76
|
| Rate for Payer: Multiplan Commercial |
$1,479.20
|
| Rate for Payer: Networks By Design Commercial |
$1,201.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,571.65
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
915354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.09
|
| Rate for Payer: Blue Shield of California Commercial |
$123.20
|
| Rate for Payer: Blue Shield of California Commercial |
$186.87
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
915354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
905354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.32 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.09
|
| Rate for Payer: Blue Shield of California Commercial |
$123.20
|
| Rate for Payer: Blue Shield of California Commercial |
$186.87
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
905354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC MULTI-POST COLLAR
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT L0180
|
| Hospital Charge Code |
915350180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.24
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
|
|
HC MULTI-POST COLLAR
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT L0180
|
| Hospital Charge Code |
905350180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.24 |
| Max. Negotiated Rate |
$702.10 |
| Rate for Payer: Adventist Health Commercial |
$338.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.98
|
| Rate for Payer: Blue Shield of California Commercial |
$635.19
|
| Rate for Payer: Blue Shield of California Commercial |
$418.78
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$298.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$578.20
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Networks By Design Commercial |
$413.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC MULTI-POST COLLAR
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT L0180
|
| Hospital Charge Code |
905350180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.24
|
| Rate for Payer: Multiplan Commercial |
$660.80
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
|
