|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
915356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,679.68 |
| Max. Negotiated Rate |
$13,032.20 |
| Rate for Payer: Adventist Health Commercial |
$6,286.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,432.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,499.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,880.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11,315.02
|
| Rate for Payer: Blue Shield of California EPN |
$7,451.35
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,032.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,032.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,174.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,226.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,982.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,490.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,732.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,732.40
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13,032.20
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
905356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,679.68 |
| Max. Negotiated Rate |
$13,032.20 |
| Rate for Payer: Adventist Health Commercial |
$6,286.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,432.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,499.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,880.29
|
| Rate for Payer: Blue Shield of California Commercial |
$11,315.02
|
| Rate for Payer: Blue Shield of California EPN |
$7,451.35
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,032.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,032.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,174.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,226.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,982.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,490.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,732.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,732.40
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,032.20
|
| Rate for Payer: Vantage Medical Group Senior |
$13,032.20
|
|
|
HC BE EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$15,332.00
|
|
|
Service Code
|
CPT L6930
|
| Hospital Charge Code |
915356930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,066.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,066.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cash Price |
$6,899.40
|
| Rate for Payer: Cigna of CA HMO |
$10,732.40
|
| Rate for Payer: Cigna of CA PPO |
$10,732.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,132.80
|
| Rate for Payer: Galaxy Health WC |
$13,032.20
|
| Rate for Payer: Global Benefits Group Commercial |
$9,199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,226.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,841.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,490.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,679.68
|
| Rate for Payer: Multiplan Commercial |
$12,265.60
|
| Rate for Payer: Networks By Design Commercial |
$7,666.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,032.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,754.10
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,479.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,021.23
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
OP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
915356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,796.16 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$8,193.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,991.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,988.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,574.73
|
| Rate for Payer: Blue Shield of California Commercial |
$14,748.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,712.22
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,986.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,036.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,329.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,957.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,370.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,988.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,988.80
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16,986.40
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
IP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
905356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,996.80 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$3,996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,329.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,613.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,370.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
OP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
905356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,796.16 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$8,193.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,991.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,988.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,574.73
|
| Rate for Payer: Blue Shield of California Commercial |
$14,748.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,712.22
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,986.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,036.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,329.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,957.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,370.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,988.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,988.80
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,990.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,990.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,986.40
|
| Rate for Payer: Vantage Medical Group Senior |
$16,986.40
|
|
|
HC BE EXT POWER MYOLELECTRIC CONT
|
Facility
|
IP
|
$19,984.00
|
|
|
Service Code
|
CPT L6935
|
| Hospital Charge Code |
915356935
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,996.80 |
| Max. Negotiated Rate |
$16,986.40 |
| Rate for Payer: Adventist Health Commercial |
$3,996.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cash Price |
$8,992.80
|
| Rate for Payer: Cigna of CA HMO |
$13,988.80
|
| Rate for Payer: Cigna of CA PPO |
$13,988.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,993.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,993.60
|
| Rate for Payer: Galaxy Health WC |
$16,986.40
|
| Rate for Payer: Global Benefits Group Commercial |
$11,990.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,329.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,613.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,370.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,796.16
|
| Rate for Payer: Multiplan Commercial |
$15,987.20
|
| Rate for Payer: Networks By Design Commercial |
$9,992.00
|
| Rate for Payer: Prime Health Services Commercial |
$16,986.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,300.16
|
| Rate for Payer: United Healthcare HMO Rider |
$7,142.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,544.76
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
IP
|
$802.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$160.40 |
| Max. Negotiated Rate |
$681.70 |
| Rate for Payer: Adventist Health Commercial |
$160.40
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Senior |
$320.80
|
| Rate for Payer: Galaxy Health WC |
$681.70
|
| Rate for Payer: Global Benefits Group Commercial |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$534.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$305.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$496.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.48
|
| Rate for Payer: Multiplan Commercial |
$641.60
|
| Rate for Payer: Networks By Design Commercial |
$521.30
|
| Rate for Payer: Prime Health Services Commercial |
$681.70
|
|
|
HC BEHAVIORAL & QUALITATIVE ANALYSIS VOICE & RESONANCE
|
Facility
|
OP
|
$802.00
|
|
|
Service Code
|
CPT 92524
|
| Hospital Charge Code |
900100021
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$90.45 |
| Max. Negotiated Rate |
$681.70 |
| Rate for Payer: Adventist Health Commercial |
$328.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$526.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$681.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$441.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$601.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cigna of CA HMO |
$513.28
|
| Rate for Payer: Cigna of CA PPO |
$593.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$681.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$681.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$681.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.80
|
| Rate for Payer: EPIC Health Plan Senior |
$320.80
|
| Rate for Payer: Galaxy Health WC |
$681.70
|
| Rate for Payer: Global Benefits Group Commercial |
$481.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$534.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$496.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$561.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$561.40
|
| Rate for Payer: Multiplan Commercial |
$641.60
|
| Rate for Payer: Networks By Design Commercial |
$521.30
|
| Rate for Payer: Prime Health Services Commercial |
$681.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$481.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$481.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$681.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$681.70
|
| Rate for Payer: Vantage Medical Group Senior |
$681.70
|
|
|
HC BELOW/ABOVE ELBOW LOCK MECH
|
Facility
|
OP
|
$1,542.13
|
|
|
Service Code
|
CPT L6698
|
| Hospital Charge Code |
915356698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$370.11 |
| Max. Negotiated Rate |
$1,310.81 |
| Rate for Payer: Adventist Health Commercial |
$632.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$848.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,156.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$893.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,138.09
|
| Rate for Payer: Blue Shield of California EPN |
$749.48
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cigna of CA HMO |
$1,079.49
|
| Rate for Payer: Cigna of CA PPO |
$1,079.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,310.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.85
|
| Rate for Payer: EPIC Health Plan Senior |
$616.85
|
| Rate for Payer: Galaxy Health WC |
$1,310.81
|
| Rate for Payer: Global Benefits Group Commercial |
$925.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,028.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$954.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,079.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,079.49
|
| Rate for Payer: Multiplan Commercial |
$1,233.70
|
| Rate for Payer: Networks By Design Commercial |
$771.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,310.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$925.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$925.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.76
|
| Rate for Payer: United Healthcare All Other HMO |
$563.34
|
| Rate for Payer: United Healthcare HMO Rider |
$551.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,310.81
|
|
|
HC BELOW/ABOVE ELBOW LOCK MECH
|
Facility
|
IP
|
$1,542.13
|
|
|
Service Code
|
CPT L6698
|
| Hospital Charge Code |
915356698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$308.43 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$308.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cigna of CA HMO |
$1,079.49
|
| Rate for Payer: Cigna of CA PPO |
$1,079.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.85
|
| Rate for Payer: EPIC Health Plan Senior |
$616.85
|
| Rate for Payer: Galaxy Health WC |
$1,310.81
|
| Rate for Payer: Global Benefits Group Commercial |
$925.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,028.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$954.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.11
|
| Rate for Payer: Multiplan Commercial |
$1,233.70
|
| Rate for Payer: Networks By Design Commercial |
$771.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,310.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.76
|
| Rate for Payer: United Healthcare All Other HMO |
$563.34
|
| Rate for Payer: United Healthcare HMO Rider |
$551.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.05
|
|
|
HC BELOW/ABOVE ELBOW LOCK MECH
|
Facility
|
OP
|
$1,542.13
|
|
|
Service Code
|
CPT L6698
|
| Hospital Charge Code |
905356698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$370.11 |
| Max. Negotiated Rate |
$1,310.81 |
| Rate for Payer: Adventist Health Commercial |
$632.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$848.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,156.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$893.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,138.09
|
| Rate for Payer: Blue Shield of California EPN |
$749.48
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cigna of CA HMO |
$1,079.49
|
| Rate for Payer: Cigna of CA PPO |
$1,079.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,310.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.85
|
| Rate for Payer: EPIC Health Plan Senior |
$616.85
|
| Rate for Payer: Galaxy Health WC |
$1,310.81
|
| Rate for Payer: Global Benefits Group Commercial |
$925.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$714.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,028.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$954.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,079.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,079.49
|
| Rate for Payer: Multiplan Commercial |
$1,233.70
|
| Rate for Payer: Networks By Design Commercial |
$771.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,310.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$925.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$925.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.76
|
| Rate for Payer: United Healthcare All Other HMO |
$563.34
|
| Rate for Payer: United Healthcare HMO Rider |
$551.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,310.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,310.81
|
|
|
HC BELOW/ABOVE ELBOW LOCK MECH
|
Facility
|
IP
|
$1,542.13
|
|
|
Service Code
|
CPT L6698
|
| Hospital Charge Code |
905356698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$308.43 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$308.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cash Price |
$693.96
|
| Rate for Payer: Cigna of CA HMO |
$1,079.49
|
| Rate for Payer: Cigna of CA PPO |
$1,079.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.85
|
| Rate for Payer: EPIC Health Plan Senior |
$616.85
|
| Rate for Payer: Galaxy Health WC |
$1,310.81
|
| Rate for Payer: Global Benefits Group Commercial |
$925.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,028.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$954.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.11
|
| Rate for Payer: Multiplan Commercial |
$1,233.70
|
| Rate for Payer: Networks By Design Commercial |
$771.07
|
| Rate for Payer: Prime Health Services Commercial |
$1,310.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$578.76
|
| Rate for Payer: United Healthcare All Other HMO |
$563.34
|
| Rate for Payer: United Healthcare HMO Rider |
$551.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.05
|
|
|
HC BELOW KNEE SUS/SEAL SLEEVE
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT L5685
|
| Hospital Charge Code |
915355685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO |
$177.10
|
| Rate for Payer: Cigna of CA PPO |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$126.50
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.95
|
| Rate for Payer: United Healthcare All Other HMO |
$92.42
|
| Rate for Payer: United Healthcare HMO Rider |
$90.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.86
|
|
|
HC BELOW KNEE SUS/SEAL SLEEVE
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT L5685
|
| Hospital Charge Code |
915355685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$103.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.54
|
| Rate for Payer: Blue Shield of California Commercial |
$186.71
|
| Rate for Payer: Blue Shield of California EPN |
$122.96
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO |
$177.10
|
| Rate for Payer: Cigna of CA PPO |
$177.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.10
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$126.50
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.95
|
| Rate for Payer: United Healthcare All Other HMO |
$92.42
|
| Rate for Payer: United Healthcare HMO Rider |
$90.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Vantage Medical Group Senior |
$215.05
|
|
|
HC BELOW KNEE SUS/SEAL SLEEVE
|
Facility
|
OP
|
$253.00
|
|
|
Service Code
|
CPT L5685
|
| Hospital Charge Code |
905355685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$215.05 |
| Rate for Payer: Adventist Health Commercial |
$103.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.54
|
| Rate for Payer: Blue Shield of California Commercial |
$186.71
|
| Rate for Payer: Blue Shield of California EPN |
$122.96
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO |
$177.10
|
| Rate for Payer: Cigna of CA PPO |
$177.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$177.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$177.10
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$126.50
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.95
|
| Rate for Payer: United Healthcare All Other HMO |
$92.42
|
| Rate for Payer: United Healthcare HMO Rider |
$90.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$215.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Vantage Medical Group Senior |
$215.05
|
|
|
HC BELOW KNEE SUS/SEAL SLEEVE
|
Facility
|
IP
|
$253.00
|
|
|
Service Code
|
CPT L5685
|
| Hospital Charge Code |
905355685
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cash Price |
$113.85
|
| Rate for Payer: Cigna of CA HMO |
$177.10
|
| Rate for Payer: Cigna of CA PPO |
$177.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.20
|
| Rate for Payer: EPIC Health Plan Senior |
$101.20
|
| Rate for Payer: Galaxy Health WC |
$215.05
|
| Rate for Payer: Global Benefits Group Commercial |
$151.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$156.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: Networks By Design Commercial |
$126.50
|
| Rate for Payer: Prime Health Services Commercial |
$215.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.95
|
| Rate for Payer: United Healthcare All Other HMO |
$92.42
|
| Rate for Payer: United Healthcare HMO Rider |
$90.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.86
|
|
|
HC BELT BACK SUPPORT SMALL
|
Facility
|
OP
|
$88.62
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901603587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.27 |
| Max. Negotiated Rate |
$75.33 |
| Rate for Payer: Adventist Health Commercial |
$36.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.33
|
| Rate for Payer: Blue Shield of California Commercial |
$65.40
|
| Rate for Payer: Blue Shield of California EPN |
$43.07
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cigna of CA HMO |
$62.03
|
| Rate for Payer: Cigna of CA PPO |
$62.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$75.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.45
|
| Rate for Payer: EPIC Health Plan Senior |
$35.45
|
| Rate for Payer: Galaxy Health WC |
$75.33
|
| Rate for Payer: Global Benefits Group Commercial |
$53.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$62.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$62.03
|
| Rate for Payer: Multiplan Commercial |
$70.90
|
| Rate for Payer: Networks By Design Commercial |
$44.31
|
| Rate for Payer: Prime Health Services Commercial |
$75.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$53.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$53.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.26
|
| Rate for Payer: United Healthcare All Other HMO |
$32.37
|
| Rate for Payer: United Healthcare HMO Rider |
$31.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$75.33
|
| Rate for Payer: Vantage Medical Group Senior |
$75.33
|
|
|
HC BELT BACK SUPPORT SMALL
|
Facility
|
IP
|
$88.62
|
|
|
Service Code
|
CPT L0625
|
| Hospital Charge Code |
901603587
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.72 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$17.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cash Price |
$39.88
|
| Rate for Payer: Cigna of CA HMO |
$62.03
|
| Rate for Payer: Cigna of CA PPO |
$62.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.45
|
| Rate for Payer: EPIC Health Plan Senior |
$35.45
|
| Rate for Payer: Galaxy Health WC |
$75.33
|
| Rate for Payer: Global Benefits Group Commercial |
$53.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.27
|
| Rate for Payer: Multiplan Commercial |
$70.90
|
| Rate for Payer: Networks By Design Commercial |
$44.31
|
| Rate for Payer: Prime Health Services Commercial |
$75.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.26
|
| Rate for Payer: United Healthcare All Other HMO |
$32.37
|
| Rate for Payer: United Healthcare HMO Rider |
$31.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.02
|
|
|
HC BE MOLD SKT FLEX HNG TRICP PAD
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT L6100
|
| Hospital Charge Code |
915356100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.80
|
| Rate for Payer: Multiplan Commercial |
$1,696.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
|
|
HC BE MOLD SKT FLEX HNG TRICP PAD
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT L6100
|
| Hospital Charge Code |
915356100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$508.80 |
| Max. Negotiated Rate |
$1,802.00 |
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Adventist Health Commercial |
$869.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,166.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,590.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,227.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,564.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.32
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,369.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,548.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,484.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,696.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.00
|
|
|
HC BE MOLD SKT FLEX HNG TRICP PAD
|
Facility
|
IP
|
$2,120.00
|
|
|
Service Code
|
CPT L6100
|
| Hospital Charge Code |
905356100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$424.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$424.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.80
|
| Rate for Payer: Multiplan Commercial |
$1,696.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
|
|
HC BE MOLD SKT FLEX HNG TRICP PAD
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT L6100
|
| Hospital Charge Code |
905356100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$508.80 |
| Max. Negotiated Rate |
$1,802.00 |
| Rate for Payer: Adventist Health Commercial |
$869.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,166.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,590.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,227.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,564.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.32
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna of CA HMO |
$1,484.00
|
| Rate for Payer: Cigna of CA PPO |
$1,484.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,802.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,802.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.00
|
| Rate for Payer: EPIC Health Plan Senior |
$848.00
|
| Rate for Payer: Galaxy Health WC |
$1,802.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,272.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,369.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,548.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,312.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,484.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,484.00
|
| Rate for Payer: Multiplan Commercial |
$1,696.00
|
| Rate for Payer: Networks By Design Commercial |
$1,060.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,802.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,272.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.64
|
| Rate for Payer: United Healthcare All Other HMO |
$774.44
|
| Rate for Payer: United Healthcare HMO Rider |
$757.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,802.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,802.00
|
|
|
HC BE MOLD SKT MUENSTER SUSPENSN
|
Facility
|
IP
|
$4,675.00
|
|
|
Service Code
|
CPT L6110
|
| Hospital Charge Code |
905356110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$935.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cigna of CA HMO |
$3,272.50
|
| Rate for Payer: Cigna of CA PPO |
$3,272.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,870.00
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,118.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,781.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,893.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,740.00
|
| Rate for Payer: Networks By Design Commercial |
$2,337.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,754.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1,707.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,670.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,531.06
|
|
|
HC BE MOLD SKT MUENSTER SUSPENSN
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
CPT L6110
|
| Hospital Charge Code |
905356110
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$3,973.75 |
| Rate for Payer: Adventist Health Commercial |
$1,916.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,973.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,571.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,506.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,707.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,450.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,272.05
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cigna of CA HMO |
$3,272.50
|
| Rate for Payer: Cigna of CA PPO |
$3,272.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,973.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,973.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,973.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,870.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,870.00
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,433.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,118.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,620.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,893.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,122.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,272.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,272.50
|
| Rate for Payer: Multiplan Commercial |
$3,740.00
|
| Rate for Payer: Networks By Design Commercial |
$2,337.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,805.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,754.53
|
| Rate for Payer: United Healthcare All Other HMO |
$1,707.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,670.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,531.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,973.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,973.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,973.75
|
|
