|
HC HDR INTERSTITIAL OR INTRACAVITARY BRACHY OVER 12 CHNLS
|
Facility
|
IP
|
$2,576.00
|
|
|
Service Code
|
CPT 77772
|
| Hospital Charge Code |
909100452
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$515.20 |
| Max. Negotiated Rate |
$2,318.40 |
| Rate for Payer: Adventist Health Commercial |
$515.20
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,060.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,030.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,030.40
|
| Rate for Payer: Galaxy Health WC |
$2,189.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,545.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,318.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,718.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$981.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,594.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$1,932.00
|
| Rate for Payer: Networks By Design Commercial |
$1,674.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,189.60
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,097.07 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,933.76
|
| Rate for Payer: Blue Shield of California Commercial |
$14,390.94
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,783.56
|
| Rate for Payer: InnovAge PACE Commercial |
$9,308.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,632.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,031.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Riverside University Health System MISP |
$7,446.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14,390.94
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,093.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,723.40
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$12,101.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$3,723.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14,390.94
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,093.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,723.40
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$12,101.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
|
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
915355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,097.07 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Adventist Health Commercial |
$7,632.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,962.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,933.76
|
| Rate for Payer: Blue Shield of California Commercial |
$14,390.94
|
| Rate for Payer: Blue Shield of California EPN |
$9,382.97
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Cash Price |
$10,239.35
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,824.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,824.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,783.56
|
| Rate for Payer: InnovAge PACE Commercial |
$9,308.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,493.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,632.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,031.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,031.90
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Riverside University Health System MISP |
$7,446.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,986.96
|
| Rate for Payer: United Healthcare All Other HMO |
$6,800.79
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,097.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HEAD ECHO
|
Facility
|
IP
|
$1,914.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$1,722.60 |
| Rate for Payer: Adventist Health Commercial |
$382.80
|
| Rate for Payer: Cash Price |
$1,052.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,531.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$765.60
|
| Rate for Payer: Galaxy Health WC |
$1,626.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,722.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,276.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,184.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.80
|
| Rate for Payer: Multiplan Commercial |
$1,435.50
|
| Rate for Payer: Networks By Design Commercial |
$1,244.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.90
|
|
|
HC HEAD ECHO
|
Facility
|
OP
|
$1,914.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.04 |
| Max. Negotiated Rate |
$1,722.60 |
| Rate for Payer: Adventist Health Commercial |
$382.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,162.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,124.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,161.80
|
| Rate for Payer: Blue Shield of California EPN |
$759.86
|
| Rate for Payer: Cash Price |
$1,052.70
|
| Rate for Payer: Cash Price |
$1,052.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,531.20
|
| Rate for Payer: Cigna of CA HMO |
$1,224.96
|
| Rate for Payer: Cigna of CA PPO |
$1,416.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,626.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,722.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,276.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$382.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,435.50
|
| Rate for Payer: Networks By Design Commercial |
$1,244.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.90
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,148.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC HEAD SCARVES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
|
HC HEAD SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.78
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: InnovAge PACE Commercial |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Riverside University Health System MISP |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC HEAD SCARVES
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.78
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: InnovAge PACE Commercial |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Riverside University Health System MISP |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC HEAD SCARVES
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380013
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
IP
|
$8,298.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,659.60 |
| Max. Negotiated Rate |
$7,468.20 |
| Rate for Payer: Adventist Health Commercial |
$1,659.60
|
| Rate for Payer: Cash Price |
$4,563.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,638.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,319.20
|
| Rate for Payer: Galaxy Health WC |
$7,053.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,534.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,161.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,136.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.60
|
| Rate for Payer: Multiplan Commercial |
$6,223.50
|
| Rate for Payer: Networks By Design Commercial |
$5,393.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,053.30
|
|
|
HC HEART CATH CONGENITAL R & L
|
Facility
|
OP
|
$8,298.00
|
|
|
Service Code
|
CPT 93531
|
| Hospital Charge Code |
906811251
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,659.60 |
| Max. Negotiated Rate |
$11,238.00 |
| Rate for Payer: Adventist Health Commercial |
$1,659.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,053.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,563.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,223.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$4,563.90
|
| Rate for Payer: Cash Price |
$4,563.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,638.40
|
| Rate for Payer: Cigna of CA HMO |
$5,393.70
|
| Rate for Payer: Cigna of CA PPO |
$6,140.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,053.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,053.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,053.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,319.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,319.20
|
| Rate for Payer: Galaxy Health WC |
$7,053.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,978.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,468.20
|
| Rate for Payer: InnovAge PACE Commercial |
$4,149.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,534.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,161.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,136.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,659.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,808.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,808.60
|
| Rate for Payer: Multiplan Commercial |
$6,223.50
|
| Rate for Payer: Networks By Design Commercial |
$5,393.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,053.30
|
| Rate for Payer: Riverside University Health System MISP |
$3,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,978.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,978.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,053.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,053.30
|
| Rate for Payer: Vantage Medical Group Senior |
$7,053.30
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
OP
|
$6,638.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,327.60 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$1,327.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,642.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,650.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,978.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,214.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,898.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,650.90
|
| Rate for Payer: Cash Price |
$3,650.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,310.40
|
| Rate for Payer: Cigna of CA HMO |
$4,314.70
|
| Rate for Payer: Cigna of CA PPO |
$4,912.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,642.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,642.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,642.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,655.20
|
| Rate for Payer: Galaxy Health WC |
$5,642.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,982.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,974.20
|
| Rate for Payer: InnovAge PACE Commercial |
$3,319.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,529.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,108.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,646.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,646.60
|
| Rate for Payer: Multiplan Commercial |
$4,978.50
|
| Rate for Payer: Networks By Design Commercial |
$4,314.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,642.30
|
| Rate for Payer: Riverside University Health System MISP |
$2,655.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,982.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,319.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,642.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,642.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5,642.30
|
|
|
HC HEART CATH CONGENITAL RT
|
Facility
|
IP
|
$6,638.00
|
|
|
Service Code
|
CPT 93530
|
| Hospital Charge Code |
906811250
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,327.60 |
| Max. Negotiated Rate |
$5,974.20 |
| Rate for Payer: Adventist Health Commercial |
$1,327.60
|
| Rate for Payer: Cash Price |
$3,650.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,655.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,655.20
|
| Rate for Payer: Galaxy Health WC |
$5,642.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,982.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,974.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,529.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,108.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,327.60
|
| Rate for Payer: Multiplan Commercial |
$4,978.50
|
| Rate for Payer: Networks By Design Commercial |
$4,314.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,642.30
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
OP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$842.66 |
| Max. Negotiated Rate |
$2,315.70 |
| Rate for Payer: Adventist Health Commercial |
$1,054.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,415.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,929.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,511.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,988.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.79
|
| Rate for Payer: Cash Price |
$1,415.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,058.40
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,187.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,187.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,315.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,286.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,716.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$980.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,592.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,054.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,801.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,801.10
|
| Rate for Payer: Multiplan Commercial |
$1,929.75
|
| Rate for Payer: Networks By Design Commercial |
$1,286.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,029.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,543.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,543.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,187.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,187.05
|
|
|
HC HEAVY DUTY ELBOW FEATURE
|
Facility
|
IP
|
$2,573.00
|
|
|
Service Code
|
CPT L6639
|
| Hospital Charge Code |
905356639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$514.60 |
| Max. Negotiated Rate |
$2,315.70 |
| Rate for Payer: Adventist Health Commercial |
$514.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,988.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,296.79
|
| Rate for Payer: Cash Price |
$1,415.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,058.40
|
| Rate for Payer: Cigna of CA HMO |
$1,801.10
|
| Rate for Payer: Cigna of CA PPO |
$1,801.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,029.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,029.20
|
| Rate for Payer: Galaxy Health WC |
$2,187.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,543.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,315.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,716.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$980.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,592.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$514.60
|
| Rate for Payer: Multiplan Commercial |
$1,929.75
|
| Rate for Payer: Networks By Design Commercial |
$1,672.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,187.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.65
|
| Rate for Payer: United Healthcare All Other HMO |
$939.92
|
| Rate for Payer: United Healthcare HMO Rider |
$919.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$842.66
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
915353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.09
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.18
|
| Rate for Payer: InnovAge PACE Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.18 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$61.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.09
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.18
|
| Rate for Payer: InnovAge PACE Commercial |
$75.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health System MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
915353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$115.95
|
| Rate for Payer: Blue Shield of California EPN |
$75.60
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.30
|
| Rate for Payer: United Healthcare All Other HMO |
$54.80
|
| Rate for Payer: United Healthcare HMO Rider |
$53.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.12
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.00
|
| Rate for Payer: Blue Shield of California Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.50
|
| Rate for Payer: InnovAge PACE Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Riverside University Health System MISP |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
915353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
915353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.50 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$103.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.00
|
| Rate for Payer: Blue Shield of California Commercial |
$194.80
|
| Rate for Payer: Blue Shield of California EPN |
$127.01
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.50
|
| Rate for Payer: InnovAge PACE Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Riverside University Health System MISP |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.58
|
| Rate for Payer: United Healthcare All Other HMO |
$92.06
|
| Rate for Payer: United Healthcare HMO Rider |
$90.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
