|
HC HLTH BHV INTVN INDIV 1ST 30MIN
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 96158
|
| Hospital Charge Code |
902506158
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$81.61 |
| Max. Negotiated Rate |
$817.20 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$346.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$439.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.18
|
| Rate for Payer: Blue Shield of California Commercial |
$575.67
|
| Rate for Payer: Blue Shield of California EPN |
$362.29
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Central Health Plan Commercial |
$726.40
|
| Rate for Payer: Cigna of CA HMO |
$581.12
|
| Rate for Payer: Cigna of CA PPO |
$671.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$635.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$771.80
|
| Rate for Payer: Global Benefits Group Commercial |
$544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$817.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$576.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Networks By Design Commercial |
$590.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$771.80
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$544.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$131.86 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.83
|
| Rate for Payer: Blue Shield of California Commercial |
$33.60
|
| Rate for Payer: Blue Shield of California EPN |
$21.15
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.10
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Riverside University Health System MISP |
$21.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.05
|
| Rate for Payer: Vantage Medical Group Senior |
$45.05
|
|
|
HC HLTH BV INT FMY W/PT ADD 15 MN
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 96168
|
| Hospital Charge Code |
902506168
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$47.70 |
| Rate for Payer: Adventist Health Commercial |
$10.60
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Central Health Plan Commercial |
$42.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.20
|
| Rate for Payer: EPIC Health Plan Senior |
$21.20
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.27
|
| Rate for Payer: Multiplan Commercial |
$39.75
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$72.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.96
|
| Rate for Payer: Blue Shield of California Commercial |
$141.95
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$123.90
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Riverside University Health System MISP |
$70.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.45
|
| Rate for Payer: Vantage Medical Group Senior |
$150.45
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
905351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$141.95
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
915351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.04 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$72.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.96
|
| Rate for Payer: Blue Shield of California Commercial |
$141.95
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$123.90
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$88.50
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: Riverside University Health System MISP |
$70.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.45
|
| Rate for Payer: Vantage Medical Group Senior |
$150.45
|
|
|
HC HO ABDUCTION FREJKA COVER
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT L1610
|
| Hospital Charge Code |
915351610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.40 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Adventist Health Commercial |
$35.40
|
| Rate for Payer: Blue Shield of California Commercial |
$141.95
|
| Rate for Payer: Blue Shield of California EPN |
$89.21
|
| Rate for Payer: Cash Price |
$79.65
|
| Rate for Payer: Central Health Plan Commercial |
$141.60
|
| Rate for Payer: Cigna of CA HMO |
$123.90
|
| Rate for Payer: Cigna of CA PPO |
$123.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.80
|
| Rate for Payer: EPIC Health Plan Senior |
$70.80
|
| Rate for Payer: Galaxy Health WC |
$150.45
|
| Rate for Payer: Global Benefits Group Commercial |
$106.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$132.75
|
| Rate for Payer: Networks By Design Commercial |
$115.05
|
| Rate for Payer: Prime Health Services Commercial |
$150.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.43
|
| Rate for Payer: United Healthcare All Other HMO |
$64.66
|
| Rate for Payer: United Healthcare HMO Rider |
$63.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.97
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
915351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.25 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.51
|
| Rate for Payer: Blue Shield of California Commercial |
$240.60
|
| Rate for Payer: Blue Shield of California EPN |
$151.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$190.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.59
|
| Rate for Payer: United Healthcare All Other HMO |
$109.59
|
| Rate for Payer: United Healthcare HMO Rider |
$107.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC HO ABDUCTION FREJKA TYPE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L1600
|
| Hospital Charge Code |
905351600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$141.49 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.53
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Riverside University Health System MISP |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.18
|
| Rate for Payer: Blue Shield of California Commercial |
$360.10
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Riverside University Health System MISP |
$179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
905351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California Commercial |
$360.10
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
IP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$89.80
|
| Rate for Payer: Blue Shield of California Commercial |
$360.10
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.80
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$291.85
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
|
|
HC HO ABDUCTION LLFIELD
|
Facility
|
OP
|
$449.00
|
|
|
Service Code
|
CPT L1650
|
| Hospital Charge Code |
915351650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$404.10 |
| Rate for Payer: Adventist Health Commercial |
$184.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.18
|
| Rate for Payer: Blue Shield of California Commercial |
$360.10
|
| Rate for Payer: Blue Shield of California EPN |
$226.30
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Cash Price |
$202.05
|
| Rate for Payer: Central Health Plan Commercial |
$359.20
|
| Rate for Payer: Cigna of CA HMO |
$314.30
|
| Rate for Payer: Cigna of CA PPO |
$314.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$381.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$381.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$314.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$179.60
|
| Rate for Payer: Galaxy Health WC |
$381.65
|
| Rate for Payer: Global Benefits Group Commercial |
$269.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$404.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$314.30
|
| Rate for Payer: Multiplan Commercial |
$336.75
|
| Rate for Payer: Networks By Design Commercial |
$224.50
|
| Rate for Payer: Prime Health Services Commercial |
$381.65
|
| Rate for Payer: Riverside University Health System MISP |
$179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$269.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$269.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.51
|
| Rate for Payer: United Healthcare All Other HMO |
$164.02
|
| Rate for Payer: United Healthcare HMO Rider |
$160.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$381.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$381.65
|
| Rate for Payer: Vantage Medical Group Senior |
$381.65
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.15
|
| Rate for Payer: Blue Shield of California Commercial |
$212.53
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
915351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$511.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,051.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,624.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,509.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,662.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
915351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$837.75 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$1,048.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,406.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,918.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,487.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,051.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,174.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,642.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,624.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,814.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,509.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,790.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,023.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,534.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,174.30
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$837.75 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$1,048.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,406.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,918.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,487.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,051.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,174.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,174.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,642.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,624.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,814.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,509.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,790.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,023.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,534.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,174.30
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$511.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,051.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,624.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,509.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,662.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,663.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,108.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,959.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.20
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$2,158.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
915351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,087.63 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,931.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,663.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Cash Price |
$1,494.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,126.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,108.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,244.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,959.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
