|
HC PLEURODESIS
|
Facility
|
OP
|
$2,415.00
|
|
|
Service Code
|
CPT 32560
|
| Hospital Charge Code |
909000202
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$379.66 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$483.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cash Price |
$1,086.75
|
| Rate for Payer: Cigna of CA HMO |
$1,545.60
|
| Rate for Payer: Cigna of CA PPO |
$1,787.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$2,052.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,449.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$379.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,610.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$579.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,569.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,052.75
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,449.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC PLEURX CHEST DRAIN
|
Facility
|
IP
|
$1,205.20
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$542.34
|
| Rate for Payer: Cash Price |
$542.34
|
| Rate for Payer: Cigna of CA HMO |
$843.64
|
| Rate for Payer: Cigna of CA PPO |
$843.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$482.08
|
| Rate for Payer: EPIC Health Plan Senior |
$482.08
|
| Rate for Payer: Galaxy Health WC |
$1,024.42
|
| Rate for Payer: Global Benefits Group Commercial |
$723.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$746.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Multiplan Commercial |
$964.16
|
| Rate for Payer: Networks By Design Commercial |
$602.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.31
|
| Rate for Payer: United Healthcare All Other HMO |
$440.26
|
| Rate for Payer: United Healthcare HMO Rider |
$430.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.70
|
|
|
HC PLEURX CHEST DRAIN
|
Facility
|
OP
|
$1,205.20
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.04 |
| Max. Negotiated Rate |
$1,024.42 |
| Rate for Payer: Adventist Health Commercial |
$241.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,024.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$662.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$903.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$698.05
|
| Rate for Payer: Blue Shield of California Commercial |
$889.44
|
| Rate for Payer: Blue Shield of California EPN |
$585.73
|
| Rate for Payer: Cash Price |
$542.34
|
| Rate for Payer: Cigna of CA HMO |
$843.64
|
| Rate for Payer: Cigna of CA PPO |
$843.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,024.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,024.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,024.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$482.08
|
| Rate for Payer: EPIC Health Plan Senior |
$482.08
|
| Rate for Payer: Galaxy Health WC |
$1,024.42
|
| Rate for Payer: Global Benefits Group Commercial |
$723.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$746.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$843.64
|
| Rate for Payer: Multiplan Commercial |
$964.16
|
| Rate for Payer: Networks By Design Commercial |
$602.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,024.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$723.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$723.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.31
|
| Rate for Payer: United Healthcare All Other HMO |
$440.26
|
| Rate for Payer: United Healthcare HMO Rider |
$430.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,024.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,024.42
|
| Rate for Payer: Vantage Medical Group Senior |
$1,024.42
|
|
|
HC PLEURX PERITONEAL DRAIN
|
Facility
|
IP
|
$1,973.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$394.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cigna of CA HMO |
$1,381.10
|
| Rate for Payer: Cigna of CA PPO |
$1,381.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$789.20
|
| Rate for Payer: EPIC Health Plan Senior |
$789.20
|
| Rate for Payer: Galaxy Health WC |
$1,677.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,183.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,221.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.52
|
| Rate for Payer: Multiplan Commercial |
$1,578.40
|
| Rate for Payer: Networks By Design Commercial |
$986.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,677.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$740.47
|
| Rate for Payer: United Healthcare All Other HMO |
$720.74
|
| Rate for Payer: United Healthcare HMO Rider |
$705.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$646.16
|
|
|
HC PLEURX PERITONEAL DRAIN
|
Facility
|
OP
|
$1,973.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909020016
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$394.60 |
| Max. Negotiated Rate |
$1,677.05 |
| Rate for Payer: Adventist Health Commercial |
$394.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,085.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,479.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,142.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,456.07
|
| Rate for Payer: Blue Shield of California EPN |
$958.88
|
| Rate for Payer: Cash Price |
$887.85
|
| Rate for Payer: Cigna of CA HMO |
$1,381.10
|
| Rate for Payer: Cigna of CA PPO |
$1,381.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,677.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,677.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$789.20
|
| Rate for Payer: EPIC Health Plan Senior |
$789.20
|
| Rate for Payer: Galaxy Health WC |
$1,677.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,183.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,315.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,221.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,381.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,381.10
|
| Rate for Payer: Multiplan Commercial |
$1,578.40
|
| Rate for Payer: Networks By Design Commercial |
$986.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,677.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,183.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,183.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$740.47
|
| Rate for Payer: United Healthcare All Other HMO |
$720.74
|
| Rate for Payer: United Healthcare HMO Rider |
$705.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$646.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,677.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,677.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,677.05
|
|
|
HC PLUG DECANNULATION 10.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 10.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 4.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC PLUG DECANNULATION 6.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 8.0
|
Facility
|
OP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: Cigna of CA HMO |
$24.72
|
| Rate for Payer: Cigna of CA PPO |
$28.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.03
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.31
|
| Rate for Payer: United Healthcare All Other HMO |
$19.31
|
| Rate for Payer: United Healthcare HMO Rider |
$19.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.83
|
| Rate for Payer: Vantage Medical Group Senior |
$32.83
|
|
|
HC PLUG DECANNULATION 8.0
|
Facility
|
IP
|
$38.62
|
|
| Hospital Charge Code |
900800860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$32.83 |
| Rate for Payer: Adventist Health Commercial |
$7.72
|
| Rate for Payer: Cash Price |
$17.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.45
|
| Rate for Payer: EPIC Health Plan Senior |
$15.45
|
| Rate for Payer: Galaxy Health WC |
$32.83
|
| Rate for Payer: Global Benefits Group Commercial |
$23.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.27
|
| Rate for Payer: Multiplan Commercial |
$30.90
|
| Rate for Payer: Networks By Design Commercial |
$25.10
|
| Rate for Payer: Prime Health Services Commercial |
$32.83
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
IP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.34
|
| Rate for Payer: Global Benefits Group Commercial |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$24.79
|
| Rate for Payer: Networks By Design Commercial |
$20.14
|
| Rate for Payer: Prime Health Services Commercial |
$26.34
|
|
|
HC PLUG SHILEY DISP DECANNULATION
|
Facility
|
OP
|
$30.99
|
|
| Hospital Charge Code |
900800857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.34 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.03
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.83
|
| Rate for Payer: Cigna of CA PPO |
$22.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.34
|
| Rate for Payer: Global Benefits Group Commercial |
$18.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$24.79
|
| Rate for Payer: Networks By Design Commercial |
$20.14
|
| Rate for Payer: Prime Health Services Commercial |
$26.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.49
|
| Rate for Payer: United Healthcare All Other HMO |
$15.49
|
| Rate for Payer: United Healthcare HMO Rider |
$15.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.34
|
| Rate for Payer: Vantage Medical Group Senior |
$26.34
|
|
|
HC PMIC110
|
Facility
|
OP
|
$92.47
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$18.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.38
|
| Rate for Payer: Blue Shield of California Commercial |
$61.86
|
| Rate for Payer: Blue Shield of California EPN |
$40.87
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Cigna of CA HMO |
$59.18
|
| Rate for Payer: Cigna of CA PPO |
$68.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$78.60
|
| Rate for Payer: Global Benefits Group Commercial |
$55.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$73.98
|
| Rate for Payer: Networks By Design Commercial |
$60.11
|
| Rate for Payer: Prime Health Services Commercial |
$78.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC PMIC110
|
Facility
|
IP
|
$92.47
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900913007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$78.60 |
| Rate for Payer: Adventist Health Commercial |
$18.49
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.99
|
| Rate for Payer: EPIC Health Plan Senior |
$36.99
|
| Rate for Payer: Galaxy Health WC |
$78.60
|
| Rate for Payer: Global Benefits Group Commercial |
$55.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.19
|
| Rate for Payer: Multiplan Commercial |
$73.98
|
| Rate for Payer: Networks By Design Commercial |
$60.11
|
| Rate for Payer: Prime Health Services Commercial |
$78.60
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
905354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.21
|
| Rate for Payer: Blue Shield of California Commercial |
$141.70
|
| Rate for Payer: Blue Shield of California EPN |
$93.31
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
915354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
905354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
|
|
HC PNEUMATIC ANKLE AIRCAST TYPE
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT L4350
|
| Hospital Charge Code |
915354350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$163.20 |
| Rate for Payer: Adventist Health Commercial |
$78.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.21
|
| Rate for Payer: Blue Shield of California Commercial |
$141.70
|
| Rate for Payer: Blue Shield of California EPN |
$93.31
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$134.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Senior |
$76.80
|
| Rate for Payer: Galaxy Health WC |
$163.20
|
| Rate for Payer: Global Benefits Group Commercial |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Networks By Design Commercial |
$96.00
|
| Rate for Payer: Prime Health Services Commercial |
$163.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.06
|
| Rate for Payer: United Healthcare All Other HMO |
$70.14
|
| Rate for Payer: United Healthcare HMO Rider |
$68.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.20
|
| Rate for Payer: Vantage Medical Group Senior |
$163.20
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
915354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$202.16 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.79
|
| Rate for Payer: Blue Shield of California Commercial |
$156.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.03
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$178.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
905354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
915354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC PNEUMATIC FULL LEG SPLINT
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L4370
|
| Hospital Charge Code |
905354370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$202.16 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.79
|
| Rate for Payer: Blue Shield of California Commercial |
$156.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.03
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$178.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
