|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
IP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.96
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: Networks By Design Commercial |
$2,245.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
OP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.96 |
| Max. Negotiated Rate |
$2,935.90 |
| Rate for Payer: Adventist Health Commercial |
$1,416.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,590.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,090.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,656.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,751.18
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,935.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,935.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,135.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,283.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,417.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,417.80
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,072.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,072.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,935.90
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$605.20 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.97
|
| Rate for Payer: Blue Shield of California Commercial |
$547.53
|
| Rate for Payer: Blue Shield of California Commercial |
$360.98
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.40
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.22 |
| Max. Negotiated Rate |
$605.20 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.97
|
| Rate for Payer: Blue Shield of California Commercial |
$547.53
|
| Rate for Payer: Blue Shield of California Commercial |
$360.98
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$498.40
|
| Rate for Payer: Multiplan Commercial |
$569.60
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.51
|
| Rate for Payer: Blue Shield of California Commercial |
$799.76
|
| Rate for Payer: Blue Shield of California Commercial |
$527.28
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$884.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$361.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$728.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$728.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$884.00
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.60 |
| Max. Negotiated Rate |
$884.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.51
|
| Rate for Payer: Blue Shield of California Commercial |
$799.76
|
| Rate for Payer: Blue Shield of California Commercial |
$527.28
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$884.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$361.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$728.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$728.00
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$884.00
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
905356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$850.85 |
| Rate for Payer: Adventist Health Commercial |
$410.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$550.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$750.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$605.91
|
| Rate for Payer: Blue Shield of California Commercial |
$769.77
|
| Rate for Payer: Blue Shield of California Commercial |
$507.51
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$850.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$700.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.70
|
| Rate for Payer: Multiplan Commercial |
$800.80
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$600.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$600.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$850.85
|
| Rate for Payer: Vantage Medical Group Senior |
$850.85
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
915356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$200.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.24
|
| Rate for Payer: Multiplan Commercial |
$800.80
|
| Rate for Payer: Networks By Design Commercial |
$650.65
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
905356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$200.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.24
|
| Rate for Payer: Multiplan Commercial |
$800.80
|
| Rate for Payer: Networks By Design Commercial |
$650.65
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
915356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$850.85 |
| Rate for Payer: Adventist Health Commercial |
$410.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$550.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$750.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$605.91
|
| Rate for Payer: Blue Shield of California Commercial |
$769.77
|
| Rate for Payer: Blue Shield of California Commercial |
$507.51
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$850.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$264.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$700.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.70
|
| Rate for Payer: Multiplan Commercial |
$800.80
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$600.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$600.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$850.85
|
| Rate for Payer: Vantage Medical Group Senior |
$850.85
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
905356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$183.37 |
| Rate for Payer: Adventist Health Commercial |
$82.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.67
|
| Rate for Payer: Blue Shield of California Commercial |
$154.57
|
| Rate for Payer: Blue Shield of California Commercial |
$101.91
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cigna of CA HMO |
$140.70
|
| Rate for Payer: Cigna of CA PPO |
$140.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.70
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Networks By Design Commercial |
$100.50
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.44
|
| Rate for Payer: United Healthcare All Other HMO |
$73.43
|
| Rate for Payer: United Healthcare HMO Rider |
$71.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.85
|
| Rate for Payer: Vantage Medical Group Senior |
$170.85
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
905356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cigna of CA HMO |
$140.70
|
| Rate for Payer: Cigna of CA PPO |
$140.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.24
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.44
|
| Rate for Payer: United Healthcare All Other HMO |
$73.43
|
| Rate for Payer: United Healthcare HMO Rider |
$71.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.83
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
915356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
915356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.96 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: Adventist Health Commercial |
$165.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.54
|
| Rate for Payer: Blue Shield of California Commercial |
$310.68
|
| Rate for Payer: Blue Shield of California Commercial |
$204.83
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$202.00
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
IP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
915357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,459.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,459.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,107.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$4,743.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
OP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
905357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,751.28 |
| Max. Negotiated Rate |
$6,202.45 |
| Rate for Payer: Adventist Health Commercial |
$2,991.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,013.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,472.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,416.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5,611.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,699.58
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,202.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,202.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,107.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,153.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,435.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,107.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,107.90
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,378.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,378.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,202.45
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
OP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
915357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,751.28 |
| Max. Negotiated Rate |
$6,202.45 |
| Rate for Payer: Adventist Health Commercial |
$2,991.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,013.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,472.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,416.87
|
| Rate for Payer: Blue Shield of California Commercial |
$5,611.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,699.58
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,202.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,202.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,107.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,153.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,435.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,107.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,107.90
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,378.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,378.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,202.45
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
IP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
905357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,459.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,459.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,107.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$4,743.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
|
|
HC TDT EACH MARKER
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC TDT EACH MARKER
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$361.51 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$361.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.84
|
| Rate for Payer: Blue Shield of California Commercial |
$95.89
|
| Rate for Payer: Blue Shield of California Commercial |
$144.98
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.80
|
| Rate for Payer: Vantage Medical Group Senior |
$176.80
|
|
|
HC TD TOXOIDS ADULT ADMIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
