|
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 |
$21.24
|
| 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 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 |
$21.24
|
| 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 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 |
$21.24
|
| 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 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 |
$21.24
|
| 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 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 |
$17.04
|
| 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 |
$17.04
|
| 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
|
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 |
$50.86
|
| 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 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 |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| Rate for Payer: Cash Price |
$50.86
|
| 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 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 |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| 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 |
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 |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| 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 |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| 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 |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| 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 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 |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| 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 |
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 |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| 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 |
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 |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| 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 |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| 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 KNEE SPLINT
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT L4380
|
| Hospital Charge Code |
905354380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$39.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$109.45
|
| Rate for Payer: Cash Price |
$109.45
|
| Rate for Payer: Cigna of CA HMO |
$139.30
|
| Rate for Payer: Cigna of CA PPO |
$139.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$99.50
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.68
|
| Rate for Payer: United Healthcare All Other HMO |
$72.69
|
| Rate for Payer: United Healthcare HMO Rider |
$71.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
|
|
HC PNEUMATIC KNEE SPLINT
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT L4380
|
| Hospital Charge Code |
905354380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.76 |
| Max. Negotiated Rate |
$169.15 |
| Rate for Payer: Adventist Health Commercial |
$81.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$109.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$149.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.26
|
| Rate for Payer: Blue Shield of California Commercial |
$146.86
|
| Rate for Payer: Blue Shield of California EPN |
$96.71
|
| Rate for Payer: Cash Price |
$109.45
|
| Rate for Payer: Cigna of CA HMO |
$139.30
|
| Rate for Payer: Cigna of CA PPO |
$139.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$169.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$169.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$169.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.60
|
| Rate for Payer: EPIC Health Plan Senior |
$79.60
|
| Rate for Payer: Galaxy Health WC |
$169.15
|
| Rate for Payer: Global Benefits Group Commercial |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$139.30
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Networks By Design Commercial |
$99.50
|
| Rate for Payer: Prime Health Services Commercial |
$169.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$119.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$119.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.68
|
| Rate for Payer: United Healthcare All Other HMO |
$72.69
|
| Rate for Payer: United Healthcare HMO Rider |
$71.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$169.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$169.15
|
| Rate for Payer: Vantage Medical Group Senior |
$169.15
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
915354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
905354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$459.85 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.35
|
| Rate for Payer: Blue Shield of California Commercial |
$399.26
|
| Rate for Payer: Blue Shield of California EPN |
$262.93
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
905354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$108.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$206.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
|
|
HC PNEUMATIC WALKING CAST
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT L4360
|
| Hospital Charge Code |
915354360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.84 |
| Max. Negotiated Rate |
$459.85 |
| Rate for Payer: Adventist Health Commercial |
$221.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.35
|
| Rate for Payer: Blue Shield of California Commercial |
$399.26
|
| Rate for Payer: Blue Shield of California EPN |
$262.93
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cash Price |
$297.55
|
| Rate for Payer: Cigna of CA HMO |
$378.70
|
| Rate for Payer: Cigna of CA PPO |
$378.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$216.40
|
| Rate for Payer: Galaxy Health WC |
$459.85
|
| Rate for Payer: Global Benefits Group Commercial |
$324.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$282.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$378.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$378.70
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: Networks By Design Commercial |
$270.50
|
| Rate for Payer: Prime Health Services Commercial |
$459.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.04
|
| Rate for Payer: United Healthcare All Other HMO |
$197.63
|
| Rate for Payer: United Healthcare HMO Rider |
$193.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$177.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.85
|
| Rate for Payer: Vantage Medical Group Senior |
$459.85
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC PNEUMOCYSTIS STAIN
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911625
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$123.10
|
| Rate for Payer: Blue Shield of California EPN |
$81.33
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cash Price |
$101.20
|
| Rate for Payer: Cigna of CA HMO |
$117.76
|
| Rate for Payer: Cigna of CA PPO |
$136.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PNEUMOTHORAX SET (COOK)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001015
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
