|
HC GUIDEWR,STRT CURVED .025"X50CM
|
Facility
|
OP
|
$248.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$224.03 |
| Rate for Payer: Adventist Health Commercial |
$49.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.19
|
| Rate for Payer: Blue Shield of California Commercial |
$152.09
|
| Rate for Payer: Blue Shield of California EPN |
$99.32
|
| Rate for Payer: Cash Price |
$136.91
|
| Rate for Payer: Central Health Plan Commercial |
$199.14
|
| Rate for Payer: Cigna of CA HMO |
$159.31
|
| Rate for Payer: Cigna of CA PPO |
$184.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.57
|
| Rate for Payer: EPIC Health Plan Senior |
$99.57
|
| Rate for Payer: Galaxy Health WC |
$211.58
|
| Rate for Payer: Global Benefits Group Commercial |
$149.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.03
|
| Rate for Payer: InnovAge PACE Commercial |
$124.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.24
|
| Rate for Payer: Multiplan Commercial |
$186.69
|
| Rate for Payer: Networks By Design Commercial |
$161.80
|
| Rate for Payer: Prime Health Services Commercial |
$211.58
|
| Rate for Payer: Riverside University Health System MISP |
$99.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.46
|
| Rate for Payer: United Healthcare All Other HMO |
$124.46
|
| Rate for Payer: United Healthcare HMO Rider |
$124.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.58
|
| Rate for Payer: Vantage Medical Group Senior |
$211.58
|
|
|
HC GUIDEWR,STRT CURVED .025"X50CM
|
Facility
|
IP
|
$248.92
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$224.03 |
| Rate for Payer: Adventist Health Commercial |
$49.78
|
| Rate for Payer: Cash Price |
$136.91
|
| Rate for Payer: Central Health Plan Commercial |
$199.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.57
|
| Rate for Payer: EPIC Health Plan Senior |
$99.57
|
| Rate for Payer: Galaxy Health WC |
$211.58
|
| Rate for Payer: Global Benefits Group Commercial |
$149.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.78
|
| Rate for Payer: Multiplan Commercial |
$186.69
|
| Rate for Payer: Networks By Design Commercial |
$161.80
|
| Rate for Payer: Prime Health Services Commercial |
$211.58
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
915353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Blue Shield of California Commercial |
$168.51
|
| Rate for Payer: Blue Shield of California EPN |
$109.87
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
905353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.03
|
| Rate for Payer: Blue Shield of California Commercial |
$168.51
|
| Rate for Payer: Blue Shield of California EPN |
$109.87
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.78
|
| Rate for Payer: InnovAge PACE Commercial |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$109.00
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Riverside University Health System MISP |
$87.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
915353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.78 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.03
|
| Rate for Payer: Blue Shield of California Commercial |
$168.51
|
| Rate for Payer: Blue Shield of California EPN |
$109.87
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.78
|
| Rate for Payer: InnovAge PACE Commercial |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$109.00
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Riverside University Health System MISP |
$87.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC HALLUS-VALGUS SPLINT EA
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT L3100
|
| Hospital Charge Code |
905353100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Blue Shield of California Commercial |
$168.51
|
| Rate for Payer: Blue Shield of California EPN |
$109.87
|
| Rate for Payer: Cash Price |
$119.90
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$152.60
|
| Rate for Payer: Cigna of CA PPO |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.82
|
| Rate for Payer: United Healthcare All Other HMO |
$79.64
|
| Rate for Payer: United Healthcare HMO Rider |
$77.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.39
|
|
|
HC HALO ADDITION MRI COMPATIBLE
|
Facility
|
OP
|
$2,933.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$960.56 |
| Max. Negotiated Rate |
$2,639.70 |
| Rate for Payer: Adventist Health Commercial |
$1,202.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,613.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,199.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,722.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,267.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,478.23
|
| Rate for Payer: Cash Price |
$1,613.15
|
| Rate for Payer: Cash Price |
$1,613.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,346.40
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,493.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,493.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,173.20
|
| Rate for Payer: Galaxy Health WC |
$2,493.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,639.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,466.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,815.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,053.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,053.10
|
| Rate for Payer: Multiplan Commercial |
$2,199.75
|
| Rate for Payer: Networks By Design Commercial |
$1,466.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,173.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,759.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,048.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$960.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,493.05
|
|
|
HC HALO ADDITION MRI COMPATIBLE
|
Facility
|
IP
|
$2,933.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,639.70 |
| Rate for Payer: Adventist Health Commercial |
$586.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,267.21
|
| Rate for Payer: Blue Shield of California EPN |
$1,478.23
|
| Rate for Payer: Cash Price |
$1,613.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,346.40
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,173.20
|
| Rate for Payer: Galaxy Health WC |
$2,493.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,639.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,815.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.60
|
| Rate for Payer: Multiplan Commercial |
$2,199.75
|
| Rate for Payer: Networks By Design Commercial |
$1,906.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,071.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,048.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$960.56
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$723.77 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,297.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,547.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Riverside University Health System MISP |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$723.77 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$906.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,657.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,297.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,878.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,547.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,547.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Riverside University Health System MISP |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
915350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,113.84
|
| Rate for Payer: Cash Price |
$1,215.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$829.41
|
| Rate for Payer: United Healthcare All Other HMO |
$807.31
|
| Rate for Payer: United Healthcare HMO Rider |
$789.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$723.77
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,060.82 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,488.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7,224.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,330.70
|
| Rate for Payer: InnovAge PACE Commercial |
$4,673.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,831.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,542.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Riverside University Health System MISP |
$3,738.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
OP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,060.82 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$3,831.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,140.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,488.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7,224.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,944.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,944.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,330.70
|
| Rate for Payer: InnovAge PACE Commercial |
$4,673.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,783.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,831.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,542.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,542.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$4,673.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: Riverside University Health System MISP |
$3,738.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,607.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,607.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,944.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,944.10
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
915350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,224.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$6,074.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
|
HC HALO PROCEDURE W/MILWAUKEE
|
Facility
|
IP
|
$9,346.00
|
|
|
Service Code
|
CPT L0830
|
| Hospital Charge Code |
905350830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.20 |
| Max. Negotiated Rate |
$8,411.40 |
| Rate for Payer: Adventist Health Commercial |
$1,869.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,224.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,710.38
|
| Rate for Payer: Cash Price |
$5,140.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,476.80
|
| Rate for Payer: Cigna of CA HMO |
$6,542.20
|
| Rate for Payer: Cigna of CA PPO |
$6,542.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,738.40
|
| Rate for Payer: Galaxy Health WC |
$7,944.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,607.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,411.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,233.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,785.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.20
|
| Rate for Payer: Multiplan Commercial |
$7,009.50
|
| Rate for Payer: Networks By Design Commercial |
$6,074.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,944.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,507.55
|
| Rate for Payer: United Healthcare All Other HMO |
$3,414.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,340.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,060.82
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,410.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$3,708.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
IP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,141.20 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$1,141.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,410.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$3,708.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.71 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,351.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,410.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,908.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,853.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,339.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.71 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,351.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,410.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Cash Price |
$3,138.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,908.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,853.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,339.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,201.11 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,571.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,201.11
|
| Rate for Payer: InnovAge PACE Commercial |
$5,595.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,587.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,201.11 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,571.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,201.11
|
| Rate for Payer: InnovAge PACE Commercial |
$5,595.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,587.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$6,154.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$186.45
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
