|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.63
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.05
|
| Rate for Payer: InnovAge PACE Commercial |
$132.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.79 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$108.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.63
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.05
|
| Rate for Payer: InnovAge PACE Commercial |
$132.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
905351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC HO ABDUCTION PAVLIK HARNESS
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L1620
|
| Hospital Charge Code |
915351620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Blue Shield of California Commercial |
$204.84
|
| Rate for Payer: Blue Shield of California EPN |
$133.56
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other HMO |
$96.80
|
| Rate for Payer: United Healthcare HMO Rider |
$94.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.79
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$837.75 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$1,048.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,406.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,918.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,502.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,174.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,642.74
|
| Rate for Payer: InnovAge PACE Commercial |
$1,279.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,790.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,790.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,023.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,534.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,174.30
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
905351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$511.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$974.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,662.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
OP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
915351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$837.75 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$1,048.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,406.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,918.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,502.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,174.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,642.74
|
| Rate for Payer: InnovAge PACE Commercial |
$1,279.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,814.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,790.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,790.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,279.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,023.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,534.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,534.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,174.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,174.30
|
|
|
HC HO ABDUCTION POST-OP CUSTOM
|
Facility
|
IP
|
$2,558.00
|
|
|
Service Code
|
CPT L1685
|
| Hospital Charge Code |
915351685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.60 |
| Max. Negotiated Rate |
$2,302.20 |
| Rate for Payer: Adventist Health Commercial |
$511.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,977.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,289.23
|
| Rate for Payer: Cash Price |
$1,406.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,046.40
|
| Rate for Payer: Cigna of CA HMO |
$1,790.60
|
| Rate for Payer: Cigna of CA PPO |
$1,790.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,023.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,023.20
|
| Rate for Payer: Galaxy Health WC |
$2,174.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,534.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,302.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,706.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$974.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,583.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.60
|
| Rate for Payer: Multiplan Commercial |
$1,918.50
|
| Rate for Payer: Networks By Design Commercial |
$1,662.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,174.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$960.02
|
| Rate for Payer: United Healthcare All Other HMO |
$934.44
|
| Rate for Payer: United Healthcare HMO Rider |
$914.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.75
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
915351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,087.63 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,950.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,567.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,126.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,324.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905361686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,087.63 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,950.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,567.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,126.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,324.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905361686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,567.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,265.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.20
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$2,158.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
OP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,087.63 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$1,361.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,826.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,490.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,950.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,567.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,822.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,822.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,126.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,660.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,361.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,324.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,324.70
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$1,660.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,992.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,992.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,822.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,822.85
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
905351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,567.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,265.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.20
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$2,158.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
|
|
HC HO ABDUCTION POST-OP CUSTOM FIT PREFAB
|
Facility
|
IP
|
$3,321.00
|
|
|
Service Code
|
CPT L1686
|
| Hospital Charge Code |
915351686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$664.20 |
| Max. Negotiated Rate |
$2,988.90 |
| Rate for Payer: Adventist Health Commercial |
$664.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,567.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,673.78
|
| Rate for Payer: Cash Price |
$1,826.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,656.80
|
| Rate for Payer: Cigna of CA HMO |
$2,324.70
|
| Rate for Payer: Cigna of CA PPO |
$2,324.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,328.40
|
| Rate for Payer: Galaxy Health WC |
$2,822.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,992.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,988.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,215.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,265.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,055.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$664.20
|
| Rate for Payer: Multiplan Commercial |
$2,490.75
|
| Rate for Payer: Networks By Design Commercial |
$2,158.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,822.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,186.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,087.63
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
IP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
915351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$2,670.30 |
| Rate for Payer: Adventist Health Commercial |
$593.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,293.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.37
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,373.60
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,670.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,130.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,836.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$2,225.25
|
| Rate for Payer: Networks By Design Commercial |
$1,928.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.69
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
IP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
905351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$593.40 |
| Max. Negotiated Rate |
$2,670.30 |
| Rate for Payer: Adventist Health Commercial |
$593.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,293.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.37
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,373.60
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,670.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,130.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,836.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.40
|
| Rate for Payer: Multiplan Commercial |
$2,225.25
|
| Rate for Payer: Networks By Design Commercial |
$1,928.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.69
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
OP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
905351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$971.69 |
| Max. Negotiated Rate |
$2,670.30 |
| Rate for Payer: Adventist Health Commercial |
$1,216.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,631.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,225.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,742.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,293.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.37
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,373.60
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,521.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,521.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,670.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.91
|
| Rate for Payer: InnovAge PACE Commercial |
$1,483.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,482.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,836.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,216.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,076.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,076.90
|
| Rate for Payer: Multiplan Commercial |
$2,225.25
|
| Rate for Payer: Networks By Design Commercial |
$1,483.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,780.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,521.95
|
|
|
HC HO ABDUCTION RANCHO TYPE
|
Facility
|
OP
|
$2,967.00
|
|
|
Service Code
|
CPT L1680
|
| Hospital Charge Code |
915351680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$971.69 |
| Max. Negotiated Rate |
$2,670.30 |
| Rate for Payer: Adventist Health Commercial |
$1,216.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,631.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,225.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,742.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,293.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,495.37
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Cash Price |
$1,631.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,373.60
|
| Rate for Payer: Cigna of CA HMO |
$2,076.90
|
| Rate for Payer: Cigna of CA PPO |
$2,076.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,521.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,521.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,186.80
|
| Rate for Payer: Galaxy Health WC |
$2,521.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,670.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.91
|
| Rate for Payer: InnovAge PACE Commercial |
$1,483.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,978.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,482.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,836.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,216.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,076.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,076.90
|
| Rate for Payer: Multiplan Commercial |
$2,225.25
|
| Rate for Payer: Networks By Design Commercial |
$1,483.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,521.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,780.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.52
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.85
|
| Rate for Payer: United Healthcare HMO Rider |
$1,060.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$971.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,521.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,521.95
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
915351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.61 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.17
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287.45
|
| Rate for Payer: InnovAge PACE Commercial |
$347.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Riverside University Health System MISP |
$278.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
915351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
905351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC HO ABDUCTION STATIC CUSTOM
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L1640
|
| Hospital Charge Code |
905351640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.61 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.17
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$287.45
|
| Rate for Payer: InnovAge PACE Commercial |
$347.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Riverside University Health System MISP |
$278.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
905351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Adventist Health Commercial |
$113.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.09
|
| Rate for Payer: Blue Shield of California Commercial |
$213.35
|
| Rate for Payer: Blue Shield of California EPN |
$139.10
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.73
|
| Rate for Payer: InnovAge PACE Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Riverside University Health System MISP |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
915351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.39 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Adventist Health Commercial |
$113.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.09
|
| Rate for Payer: Blue Shield of California Commercial |
$213.35
|
| Rate for Payer: Blue Shield of California EPN |
$139.10
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$234.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$234.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$125.73
|
| Rate for Payer: InnovAge PACE Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$138.00
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: Riverside University Health System MISP |
$110.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$165.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$234.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.60
|
| Rate for Payer: Vantage Medical Group Senior |
$234.60
|
|
|
HC HO ABDUCTION STATIC PLASTIC
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT L1660
|
| Hospital Charge Code |
915351660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Adventist Health Commercial |
$55.20
|
| Rate for Payer: Blue Shield of California Commercial |
$213.35
|
| Rate for Payer: Blue Shield of California EPN |
$139.10
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Central Health Plan Commercial |
$220.80
|
| Rate for Payer: Cigna of CA HMO |
$193.20
|
| Rate for Payer: Cigna of CA PPO |
$193.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.40
|
| Rate for Payer: EPIC Health Plan Senior |
$110.40
|
| Rate for Payer: Galaxy Health WC |
$234.60
|
| Rate for Payer: Global Benefits Group Commercial |
$165.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$248.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$207.00
|
| Rate for Payer: Networks By Design Commercial |
$179.40
|
| Rate for Payer: Prime Health Services Commercial |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.58
|
| Rate for Payer: United Healthcare All Other HMO |
$100.82
|
| Rate for Payer: United Healthcare HMO Rider |
$98.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.39
|
|
