|
HC FOLIC ACID (SERUM)
|
Facility
|
IP
|
$129.76
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$25.95 |
| Max. Negotiated Rate |
$116.78 |
| Rate for Payer: Adventist Health Commercial |
$25.95
|
| Rate for Payer: Cash Price |
$71.37
|
| Rate for Payer: Central Health Plan Commercial |
$103.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.90
|
| Rate for Payer: EPIC Health Plan Senior |
$51.90
|
| Rate for Payer: Galaxy Health WC |
$110.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.95
|
| Rate for Payer: Multiplan Commercial |
$97.32
|
| Rate for Payer: Networks By Design Commercial |
$84.34
|
| Rate for Payer: Prime Health Services Commercial |
$110.30
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,618.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.06 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,588.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,587.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Cash Price |
$1,438.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,569.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC FO MODIFIED PIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FO MODIFIED PIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
|
|
HC FO MULTI DENSITY INSERT CUSTOM
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT A5513
|
| Hospital Charge Code |
905365513
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Adventist Health Commercial |
$26.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.35
|
| Rate for Payer: Blue Shield of California Commercial |
$79.43
|
| Rate for Payer: Blue Shield of California EPN |
$51.87
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Cash Price |
$71.50
|
| Rate for Payer: Central Health Plan Commercial |
$104.00
|
| Rate for Payer: Cigna of CA HMO |
$83.20
|
| Rate for Payer: Cigna of CA PPO |
$96.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.00
|
| Rate for Payer: EPIC Health Plan Senior |
$52.00
|
| Rate for Payer: Galaxy Health WC |
$110.50
|
| Rate for Payer: Global Benefits Group Commercial |
$78.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.73
|
| Rate for Payer: InnovAge PACE Commercial |
$65.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$80.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$97.50
|
| Rate for Payer: Networks By Design Commercial |
$84.50
|
| Rate for Payer: Prime Health Services Commercial |
$110.50
|
| Rate for Payer: Riverside University Health System MISP |
$52.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.00
|
| Rate for Payer: United Healthcare All Other HMO |
$65.00
|
| Rate for Payer: United Healthcare HMO Rider |
$65.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.50
|
| Rate for Payer: Vantage Medical Group Senior |
$110.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.81
|
| Rate for Payer: Blue Shield of California Commercial |
$255.09
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.37
|
| Rate for Payer: InnovAge PACE Commercial |
$165.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Riverside University Health System MISP |
$132.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
905353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$255.09
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$255.09
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
|
|
HC FO NONTORSION JOINT, CF
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT L3935
|
| Hospital Charge Code |
915353935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.81
|
| Rate for Payer: Blue Shield of California Commercial |
$255.09
|
| Rate for Payer: Blue Shield of California EPN |
$166.32
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Cash Price |
$181.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$231.00
|
| Rate for Payer: Cigna of CA PPO |
$231.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.37
|
| Rate for Payer: InnovAge PACE Commercial |
$165.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$231.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$165.00
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Riverside University Health System MISP |
$132.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.85
|
| Rate for Payer: United Healthcare All Other HMO |
$120.55
|
| Rate for Payer: United Healthcare HMO Rider |
$117.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: InnovAge PACE Commercial |
$290.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC FOOTBALL HELMET XL W/FACESHLD
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901608073
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$319.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC FOOT COMPLETE
|
Facility
|
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$988.20 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$666.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.40
|
| Rate for Payer: Blue Shield of California Commercial |
$666.49
|
| Rate for Payer: Blue Shield of California EPN |
$435.91
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: Cigna of CA HMO |
$702.72
|
| Rate for Payer: Cigna of CA PPO |
$812.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$732.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$658.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$658.80
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FOOT COMPLETE
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$988.20 |
| Rate for Payer: Adventist Health Commercial |
$219.60
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.20
|
| Rate for Payer: EPIC Health Plan Senior |
$439.20
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$732.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$679.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Blue Shield of California Commercial |
$115.18
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
IP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$29.80
|
| Rate for Payer: Blue Shield of California Commercial |
$115.18
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.80
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
905354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.51
|
| Rate for Payer: Blue Shield of California Commercial |
$115.18
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.64
|
| Rate for Payer: InnovAge PACE Commercial |
$74.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Riverside University Health System MISP |
$59.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT DROP SPLINT RECUMBENT
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT L4398
|
| Hospital Charge Code |
915354398
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Adventist Health Commercial |
$61.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.51
|
| Rate for Payer: Blue Shield of California Commercial |
$115.18
|
| Rate for Payer: Blue Shield of California EPN |
$75.10
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Cash Price |
$81.95
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$104.30
|
| Rate for Payer: Cigna of CA PPO |
$104.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.60
|
| Rate for Payer: EPIC Health Plan Senior |
$59.60
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.64
|
| Rate for Payer: InnovAge PACE Commercial |
$74.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.30
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$74.50
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Riverside University Health System MISP |
$59.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.92
|
| Rate for Payer: United Healthcare All Other HMO |
$54.43
|
| Rate for Payer: United Healthcare HMO Rider |
$53.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.65
|
| Rate for Payer: Vantage Medical Group Senior |
$126.65
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,228.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,463.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Riverside University Health System MISP |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.20
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
905355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.59 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$857.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,568.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,228.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,777.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,777.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$571.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,045.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$631.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$857.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,463.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,463.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,045.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: Riverside University Health System MISP |
$836.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,254.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,777.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,777.35
|
|
|
HC FOOT ENERGY STOR SEATTLE CCLL
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT L5976
|
| Hospital Charge Code |
915355976
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.20 |
| Max. Negotiated Rate |
$1,881.90 |
| Rate for Payer: Adventist Health Commercial |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.34
|
| Rate for Payer: Blue Shield of California EPN |
$1,053.86
|
| Rate for Payer: Cash Price |
$1,150.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,672.80
|
| Rate for Payer: Cigna of CA HMO |
$1,463.70
|
| Rate for Payer: Cigna of CA PPO |
$1,463.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,881.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,294.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.20
|
| Rate for Payer: Multiplan Commercial |
$1,568.25
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$784.75
|
| Rate for Payer: United Healthcare All Other HMO |
$763.84
|
| Rate for Payer: United Healthcare HMO Rider |
$747.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$684.80
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
905355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$113.80
|
| Rate for Payer: Blue Shield of California Commercial |
$439.84
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.80
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$369.85
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
|
|
HC FOOT EXTEMAL KEEL SACH FOOT
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT L5970
|
| Hospital Charge Code |
915355970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Adventist Health Commercial |
$233.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$312.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$334.17
|
| Rate for Payer: Blue Shield of California Commercial |
$439.84
|
| Rate for Payer: Blue Shield of California EPN |
$286.78
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Cash Price |
$312.95
|
| Rate for Payer: Central Health Plan Commercial |
$455.20
|
| Rate for Payer: Cigna of CA HMO |
$398.30
|
| Rate for Payer: Cigna of CA PPO |
$398.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$483.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$483.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$483.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$227.60
|
| Rate for Payer: Galaxy Health WC |
$483.65
|
| Rate for Payer: Global Benefits Group Commercial |
$341.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$512.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.63
|
| Rate for Payer: InnovAge PACE Commercial |
$284.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$379.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$398.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$398.30
|
| Rate for Payer: Multiplan Commercial |
$426.75
|
| Rate for Payer: Networks By Design Commercial |
$284.50
|
| Rate for Payer: Prime Health Services Commercial |
$483.65
|
| Rate for Payer: Riverside University Health System MISP |
$227.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$341.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.55
|
| Rate for Payer: United Healthcare All Other HMO |
$207.86
|
| Rate for Payer: United Healthcare HMO Rider |
$203.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$483.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$483.65
|
| Rate for Payer: Vantage Medical Group Senior |
$483.65
|
|
