|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
915353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
905353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
915353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
905353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.90
|
| Rate for Payer: Blue Shield of California Commercial |
$101.51
|
| Rate for Payer: Blue Shield of California Commercial |
$66.92
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
905355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: Adventist Health Commercial |
$476.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,511.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,404.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.20
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: Networks By Design Commercial |
$1,547.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
915355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.20 |
| Max. Negotiated Rate |
$2,023.00 |
| Rate for Payer: Adventist Health Commercial |
$975.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,309.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,440.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,830.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,206.66
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,023.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,137.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,511.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,286.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,404.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,666.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,666.00
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,428.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,428.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,023.00
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
915355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$476.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,511.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,404.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.20
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: Networks By Design Commercial |
$1,547.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
905355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$571.20 |
| Max. Negotiated Rate |
$2,023.00 |
| Rate for Payer: Adventist Health Commercial |
$975.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,309.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,440.61
|
| Rate for Payer: Blue Shield of California Commercial |
$1,830.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,206.66
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,023.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,137.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,511.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,286.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,404.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,666.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,666.00
|
| Rate for Payer: Multiplan Commercial |
$1,904.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,428.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,428.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,023.00
|
|
|
HC ADDL DIAG CD19
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$380.87 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$313.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$380.87
|
| Rate for Payer: Blue Shield of California Commercial |
$191.31
|
| Rate for Payer: Blue Shield of California Commercial |
$132.77
|
| Rate for Payer: Blue Shield of California Commercial |
$289.25
|
| Rate for Payer: Blue Shield of California Commercial |
$200.74
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$265.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Cigna of CA PPO |
$307.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC ADDL DIAG CD19
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$352.75 |
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: Adventist Health Commercial |
$83.00
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$290.50
|
| Rate for Payer: EPIC Health Plan Senior |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$263.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.60
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
905352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: Adventist Health Commercial |
$214.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.57
|
| Rate for Payer: Blue Shield of California Commercial |
$402.19
|
| Rate for Payer: Blue Shield of California Commercial |
$265.16
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$444.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$366.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.10
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$261.50
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
905352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
915352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
915352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: Adventist Health Commercial |
$214.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.57
|
| Rate for Payer: Blue Shield of California Commercial |
$402.19
|
| Rate for Payer: Blue Shield of California Commercial |
$265.16
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$444.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$366.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.10
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$261.50
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
905355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$497.04 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,253.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,592.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
905355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$497.04 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,253.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,592.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
905355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$497.04 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,253.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,592.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$497.04 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,253.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,592.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,050.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
905355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,315.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD. LE FOOT LAMIN/PREPREG COMPOSIT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT L3031
|
| Hospital Charge Code |
915353031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.52 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: Adventist Health Commercial |
$214.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.57
|
| Rate for Payer: Blue Shield of California Commercial |
$265.16
|
| Rate for Payer: Blue Shield of California Commercial |
$402.19
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$444.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$366.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.10
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$261.50
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC ADD. LE FOOT LAMIN/PREPREG COMPOSIT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT L3031
|
| Hospital Charge Code |
905353031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.52 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: Adventist Health Commercial |
$214.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.57
|
| Rate for Payer: Blue Shield of California Commercial |
$265.16
|
| Rate for Payer: Blue Shield of California Commercial |
$402.19
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$444.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$366.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.10
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$261.50
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC ADD. LE FOOT LAMIN/PREPREG COMPOSIT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT L3031
|
| Hospital Charge Code |
905353031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
|
