|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$723.77 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,772.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Riverside University Health System MISP |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$723.77 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,285.56
|
| Rate for Payer: Blue Shield of California Commercial |
$1,772.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Riverside University Health System MISP |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,772.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,772.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,403.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,495.49
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$6,074.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,060.82 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,436.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7,495.49
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,330.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,831.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Riverside University Health System MISP |
$3,738.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,060.82 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,436.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7,495.49
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,330.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,831.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Riverside University Health System MISP |
$3,738.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,495.49
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$4,205.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,934.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,514.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$6,074.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,576.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$3,708.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.71 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,319.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,576.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,908.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,339.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,576.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$3,708.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.71 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,319.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,576.21
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,908.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,623.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,366.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,339.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,974.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,201.11 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,509.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8,974.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,201.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,587.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,201.11 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,509.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8,974.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,201.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,587.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,974.38
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,105.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,602.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.20
|
| Rate for Payer: Blue Shield of California Commercial |
$271.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.20
|
| Rate for Payer: Blue Shield of California Commercial |
$271.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$271.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$271.88
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$215.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$200.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Adventist Health Commercial |
$198.00
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$792.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$693.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$396.00
|
| Rate for Payer: Galaxy Health WC |
$841.50
|
| Rate for Payer: Global Benefits Group Commercial |
$594.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$628.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$584.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$742.50
|
| Rate for Payer: Networks By Design Commercial |
$643.50
|
| Rate for Payer: Prime Health Services Commercial |
$841.50
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$198.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$633.60
|
| Rate for Payer: Cigna of CA PPO |
$732.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$693.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$841.50
|
| Rate for Payer: Global Benefits Group Commercial |
$594.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$628.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$742.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$643.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.00
|
| Rate for Payer: United Healthcare All Other HMO |
$495.00
|
| Rate for Payer: United Healthcare HMO Rider |
$495.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$495.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.80 |
| Max. Negotiated Rate |
$971.10 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Central Health Plan Commercial |
$863.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$755.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$431.60
|
| Rate for Payer: EPIC Health Plan Senior |
$431.60
|
| Rate for Payer: Galaxy Health WC |
$917.15
|
| Rate for Payer: Global Benefits Group Commercial |
$647.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$971.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$636.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.80
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
| Rate for Payer: Networks By Design Commercial |
$701.35
|
| Rate for Payer: Prime Health Services Commercial |
$917.15
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$971.10 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.47
|
| Rate for Payer: Blue Shield of California Commercial |
$679.77
|
| Rate for Payer: Blue Shield of California EPN |
$428.36
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Central Health Plan Commercial |
$863.20
|
| Rate for Payer: Cigna of CA HMO |
$690.56
|
| Rate for Payer: Cigna of CA PPO |
$798.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$755.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$917.15
|
| Rate for Payer: Global Benefits Group Commercial |
$647.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$971.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$685.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
| Rate for Payer: Networks By Design Commercial |
$701.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$917.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$647.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$647.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$968.40 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Central Health Plan Commercial |
$860.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$753.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.40
|
| Rate for Payer: EPIC Health Plan Senior |
$430.40
|
| Rate for Payer: Galaxy Health WC |
$914.60
|
| Rate for Payer: Global Benefits Group Commercial |
$645.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$968.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$683.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$634.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.20
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
| Rate for Payer: Networks By Design Commercial |
$699.40
|
| Rate for Payer: Prime Health Services Commercial |
$914.60
|
|
