|
HC LEATHER KAFO-AFO PORX
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
915354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.84
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEATHER KAFO-AFO PORX
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4100
|
| Hospital Charge Code |
905354100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.84
|
| Rate for Payer: Blue Shield of California Commercial |
$199.70
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
IP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Central Health Plan Commercial |
$110.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.59
|
| Rate for Payer: Multiplan Commercial |
$103.45
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
|
|
HC LEECHES - WOUND THERAPY, EA
|
Facility
|
OP
|
$137.94
|
|
| Hospital Charge Code |
901605575
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Adventist Health Commercial |
$27.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80.24
|
| Rate for Payer: Blue Shield of California Commercial |
$87.45
|
| Rate for Payer: Blue Shield of California EPN |
$55.04
|
| Rate for Payer: Cash Price |
$62.07
|
| Rate for Payer: Central Health Plan Commercial |
$110.35
|
| Rate for Payer: Cigna of CA HMO |
$88.28
|
| Rate for Payer: Cigna of CA PPO |
$102.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.18
|
| Rate for Payer: EPIC Health Plan Senior |
$55.18
|
| Rate for Payer: Galaxy Health WC |
$117.25
|
| Rate for Payer: Global Benefits Group Commercial |
$82.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$124.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$96.56
|
| Rate for Payer: Multiplan Commercial |
$103.45
|
| Rate for Payer: Networks By Design Commercial |
$89.66
|
| Rate for Payer: Prime Health Services Commercial |
$117.25
|
| Rate for Payer: Riverside University Health System MISP |
$55.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.97
|
| Rate for Payer: United Healthcare All Other HMO |
$68.97
|
| Rate for Payer: United Healthcare HMO Rider |
$68.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.25
|
| Rate for Payer: Vantage Medical Group Senior |
$117.25
|
|
|
HC LEECH THERAPY
|
Facility
|
OP
|
$2,160.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
906500660
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,311.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,045.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,256.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,369.44
|
| Rate for Payer: Blue Shield of California EPN |
$861.84
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: Cigna of CA HMO |
$1,382.40
|
| Rate for Payer: Cigna of CA PPO |
$1,598.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,512.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,371.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,404.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,296.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,296.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC LEECH THERAPY
|
Facility
|
IP
|
$2,160.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
906500660
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Adventist Health Commercial |
$432.00
|
| Rate for Payer: Cash Price |
$972.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,728.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,512.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Senior |
$864.00
|
| Rate for Payer: Galaxy Health WC |
$1,836.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,296.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,944.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,371.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,274.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,404.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,836.00
|
|
|
HC LEEP
|
Facility
|
IP
|
$7,514.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
904000025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,502.80 |
| Max. Negotiated Rate |
$6,762.60 |
| Rate for Payer: Adventist Health Commercial |
$1,502.80
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,011.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,005.60
|
| Rate for Payer: Galaxy Health WC |
$6,386.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,762.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,771.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,433.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,502.80
|
| Rate for Payer: Multiplan Commercial |
$5,635.50
|
| Rate for Payer: Networks By Design Commercial |
$4,884.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,386.90
|
|
|
HC LEEP
|
Facility
|
OP
|
$7,514.00
|
|
|
Service Code
|
CPT 57460
|
| Hospital Charge Code |
904000025
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$503.77 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,502.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,011.20
|
| Rate for Payer: Cigna of CA HMO |
$4,808.96
|
| Rate for Payer: Cigna of CA PPO |
$5,560.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,386.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,762.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$503.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,771.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$556.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,502.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$5,635.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,884.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$6,386.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,757.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
IP
|
$66,433.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,286.60 |
| Max. Negotiated Rate |
$59,789.70 |
| Rate for Payer: Adventist Health Commercial |
$13,286.60
|
| Rate for Payer: Cash Price |
$29,894.85
|
| Rate for Payer: Central Health Plan Commercial |
$53,146.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46,503.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,573.20
|
| Rate for Payer: EPIC Health Plan Senior |
$26,573.20
|
| Rate for Payer: Galaxy Health WC |
$56,468.05
|
| Rate for Payer: Global Benefits Group Commercial |
$39,859.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$59,789.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42,184.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,195.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,286.60
|
| Rate for Payer: Multiplan Commercial |
$49,824.75
|
| Rate for Payer: Networks By Design Commercial |
$43,181.45
|
| Rate for Payer: Prime Health Services Commercial |
$56,468.05
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$66,433.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.36 |
| Max. Negotiated Rate |
$59,789.70 |
| Rate for Payer: Adventist Health Commercial |
$13,286.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56,468.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36,538.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49,824.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,579.41
|
| Rate for Payer: Blue Shield of California EPN |
$6,020.76
|
| Rate for Payer: Cash Price |
$29,894.85
|
| Rate for Payer: Cash Price |
$29,894.85
|
| Rate for Payer: Cash Price |
$29,894.85
|
| Rate for Payer: Central Health Plan Commercial |
$53,146.40
|
| Rate for Payer: Cigna of CA HMO |
$42,517.12
|
| Rate for Payer: Cigna of CA PPO |
$49,160.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56,468.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$56,468.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56,468.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46,503.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,573.20
|
| Rate for Payer: EPIC Health Plan Senior |
$26,573.20
|
| Rate for Payer: Galaxy Health WC |
$56,468.05
|
| Rate for Payer: Global Benefits Group Commercial |
$39,859.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$59,789.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,167.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42,184.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,289.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39,195.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,286.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,503.10
|
| Rate for Payer: Multiplan Commercial |
$49,824.75
|
| Rate for Payer: Networks By Design Commercial |
$43,181.45
|
| Rate for Payer: Prime Health Services Commercial |
$56,468.05
|
| Rate for Payer: Riverside University Health System MISP |
$26,573.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39,859.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33,216.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56,468.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56,468.05
|
| Rate for Payer: Vantage Medical Group Senior |
$56,468.05
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$10,086.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$284.04 |
| Max. Negotiated Rate |
$15,933.00 |
| Rate for Payer: Adventist Health Commercial |
$2,017.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,573.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,547.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,564.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,538.70
|
| Rate for Payer: Cash Price |
$4,538.70
|
| Rate for Payer: Cash Price |
$4,538.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,068.80
|
| Rate for Payer: Cigna of CA HMO |
$6,555.90
|
| Rate for Payer: Cigna of CA PPO |
$7,463.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,573.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,573.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,573.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,060.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,034.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,034.40
|
| Rate for Payer: Galaxy Health WC |
$8,573.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,051.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,077.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,404.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$313.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,950.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,017.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,060.20
|
| Rate for Payer: Multiplan Commercial |
$7,564.50
|
| Rate for Payer: Networks By Design Commercial |
$6,555.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,573.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,034.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,051.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,051.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,043.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,573.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,573.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,573.10
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$10,086.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,017.20 |
| Max. Negotiated Rate |
$9,077.40 |
| Rate for Payer: Adventist Health Commercial |
$2,017.20
|
| Rate for Payer: Cash Price |
$4,538.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,068.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,060.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,034.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,034.40
|
| Rate for Payer: Galaxy Health WC |
$8,573.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,051.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,077.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,404.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,950.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,017.20
|
| Rate for Payer: Multiplan Commercial |
$7,564.50
|
| Rate for Payer: Networks By Design Commercial |
$6,555.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,573.10
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$9,166.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,833.20 |
| Max. Negotiated Rate |
$8,249.40 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Cash Price |
$4,124.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,332.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,416.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,666.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,666.40
|
| Rate for Payer: Galaxy Health WC |
$7,791.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,499.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,249.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,820.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,407.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,833.20
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
| Rate for Payer: Networks By Design Commercial |
$5,957.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,791.10
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$9,166.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,312.12 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,169.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,831.25
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$4,124.70
|
| Rate for Payer: Cash Price |
$4,124.70
|
| Rate for Payer: Cash Price |
$4,124.70
|
| Rate for Payer: Central Health Plan Commercial |
$7,332.80
|
| Rate for Payer: Cigna of CA HMO |
$5,957.90
|
| Rate for Payer: Cigna of CA PPO |
$6,782.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,416.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| Rate for Payer: Galaxy Health WC |
$7,791.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,499.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,249.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,312.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,820.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,833.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,587.36
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
| Rate for Payer: Networks By Design Commercial |
$5,957.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Prime Health Services Commercial |
$7,791.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,419.85
|
| Rate for Payer: Riverside University Health System MISP |
$4,586.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,499.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,583.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: Cigna of CA HMO |
$828.80
|
| Rate for Payer: Cigna of CA PPO |
$958.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$906.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$822.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.50
|
| Rate for Payer: United Healthcare All Other HMO |
$647.50
|
| Rate for Payer: United Healthcare HMO Rider |
$647.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$647.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$906.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.00
|
| Rate for Payer: EPIC Health Plan Senior |
$518.00
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$822.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$764.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,608.35 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,856.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,938.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,173.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,964.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,608.35 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,856.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,938.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,173.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,964.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,938.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.20
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$3,192.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,938.62
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,118.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,897.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.20
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$3,192.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,518.99
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,101.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,518.99
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Riverside University Health System MISP |
$757.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,101.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,518.99
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Riverside University Health System MISP |
$757.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,518.99
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,202.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,117.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
