|
HC ED EXP INTRFC OUTSIDE LKNG HNG
|
Facility
|
OP
|
$8,341.00
|
|
|
Service Code
|
CPT L6205
|
| Hospital Charge Code |
905356205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,001.84 |
| Max. Negotiated Rate |
$7,089.85 |
| Rate for Payer: Adventist Health Commercial |
$3,419.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,587.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,255.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,831.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6,155.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,053.73
|
| Rate for Payer: Cash Price |
$4,587.55
|
| Rate for Payer: Cash Price |
$4,587.55
|
| Rate for Payer: Cigna of CA HMO |
$5,838.70
|
| Rate for Payer: Cigna of CA PPO |
$5,838.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,089.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,089.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,336.40
|
| Rate for Payer: Galaxy Health WC |
$7,089.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,461.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,563.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,915.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,163.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,001.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,838.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,838.70
|
| Rate for Payer: Multiplan Commercial |
$6,672.80
|
| Rate for Payer: Networks By Design Commercial |
$4,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,004.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,004.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,130.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,046.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,981.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,731.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,089.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,089.85
|
|
|
HC ED EXP INTRFC OUTSIDE LKNG HNG
|
Facility
|
OP
|
$8,341.00
|
|
|
Service Code
|
CPT L6205
|
| Hospital Charge Code |
915356205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,001.84 |
| Max. Negotiated Rate |
$7,089.85 |
| Rate for Payer: Adventist Health Commercial |
$3,419.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,587.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,255.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,831.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6,155.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,053.73
|
| Rate for Payer: Cash Price |
$4,587.55
|
| Rate for Payer: Cash Price |
$4,587.55
|
| Rate for Payer: Cigna of CA HMO |
$5,838.70
|
| Rate for Payer: Cigna of CA PPO |
$5,838.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,089.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,089.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,336.40
|
| Rate for Payer: Galaxy Health WC |
$7,089.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,461.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,563.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,915.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,163.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,001.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,838.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,838.70
|
| Rate for Payer: Multiplan Commercial |
$6,672.80
|
| Rate for Payer: Networks By Design Commercial |
$4,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,004.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,004.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,130.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,046.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,981.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,731.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,089.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,089.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,089.85
|
|
|
HC ED EXP INTRFC OUTSIDE LKNG HNG
|
Facility
|
IP
|
$8,341.00
|
|
|
Service Code
|
CPT L6205
|
| Hospital Charge Code |
915356205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,668.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,668.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,587.55
|
| Rate for Payer: Cash Price |
$4,587.55
|
| Rate for Payer: Cigna of CA HMO |
$5,838.70
|
| Rate for Payer: Cigna of CA PPO |
$5,838.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,336.40
|
| Rate for Payer: Galaxy Health WC |
$7,089.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,563.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,177.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,163.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,001.84
|
| Rate for Payer: Multiplan Commercial |
$6,672.80
|
| Rate for Payer: Networks By Design Commercial |
$4,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,130.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,046.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,981.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,731.68
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
905356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,759.40 |
| Max. Negotiated Rate |
$15,977.45 |
| Rate for Payer: Adventist Health Commercial |
$3,759.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,161.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,635.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,511.28
|
| Rate for Payer: Multiplan Commercial |
$15,037.60
|
| Rate for Payer: Networks By Design Commercial |
$9,398.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
915356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,759.40 |
| Max. Negotiated Rate |
$15,977.45 |
| Rate for Payer: Adventist Health Commercial |
$3,759.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,161.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,635.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,511.28
|
| Rate for Payer: Multiplan Commercial |
$15,037.60
|
| Rate for Payer: Networks By Design Commercial |
$9,398.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
915356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,511.28 |
| Max. Negotiated Rate |
$15,977.45 |
| Rate for Payer: Adventist Health Commercial |
$7,706.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,338.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,097.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,887.22
|
| Rate for Payer: Blue Shield of California Commercial |
$13,872.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,135.34
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,977.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,977.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,636.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,505.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,635.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,511.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,157.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,157.90
|
| Rate for Payer: Multiplan Commercial |
$15,037.60
|
| Rate for Payer: Networks By Design Commercial |
$9,398.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,278.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,278.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,977.45
|
|
|
HC ED EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$18,797.00
|
|
|
Service Code
|
CPT L6940
|
| Hospital Charge Code |
905356940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,511.28 |
| Max. Negotiated Rate |
$15,977.45 |
| Rate for Payer: Adventist Health Commercial |
$7,706.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,338.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,097.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,887.22
|
| Rate for Payer: Blue Shield of California Commercial |
$13,872.19
|
| Rate for Payer: Blue Shield of California EPN |
$9,135.34
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cash Price |
$10,338.35
|
| Rate for Payer: Cigna of CA HMO |
$13,157.90
|
| Rate for Payer: Cigna of CA PPO |
$13,157.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,977.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,977.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,518.80
|
| Rate for Payer: Galaxy Health WC |
$15,977.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,278.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,636.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,505.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,635.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,511.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,157.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,157.90
|
| Rate for Payer: Multiplan Commercial |
$15,037.60
|
| Rate for Payer: Networks By Design Commercial |
$9,398.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,977.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,278.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,278.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,054.51
|
| Rate for Payer: United Healthcare All Other HMO |
$6,866.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6,718.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,156.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,977.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,977.45
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
OP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
915356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,602.32 |
| Max. Negotiated Rate |
$19,841.55 |
| Rate for Payer: Adventist Health Commercial |
$9,570.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,838.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,507.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,520.27
|
| Rate for Payer: Blue Shield of California Commercial |
$17,227.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,344.70
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,841.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,841.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,638.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,569.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,638.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,449.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,602.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,340.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,340.10
|
| Rate for Payer: Multiplan Commercial |
$18,674.40
|
| Rate for Payer: Networks By Design Commercial |
$11,671.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,005.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,005.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19,841.55
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
IP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
915356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,668.60 |
| Max. Negotiated Rate |
$19,841.55 |
| Rate for Payer: Adventist Health Commercial |
$4,668.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,569.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,893.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,449.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,602.32
|
| Rate for Payer: Multiplan Commercial |
$18,674.40
|
| Rate for Payer: Networks By Design Commercial |
$11,671.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
OP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
905356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,602.32 |
| Max. Negotiated Rate |
$19,841.55 |
| Rate for Payer: Adventist Health Commercial |
$9,570.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,838.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,507.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,520.27
|
| Rate for Payer: Blue Shield of California Commercial |
$17,227.13
|
| Rate for Payer: Blue Shield of California EPN |
$11,344.70
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,841.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,841.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,638.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,569.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,638.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,449.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,602.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,340.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,340.10
|
| Rate for Payer: Multiplan Commercial |
$18,674.40
|
| Rate for Payer: Networks By Design Commercial |
$11,671.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,005.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,005.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,841.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19,841.55
|
|
|
HC ED EXTER POWER LOCK HINGE MYOE
|
Facility
|
IP
|
$23,343.00
|
|
|
Service Code
|
CPT L6945
|
| Hospital Charge Code |
905356945
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,668.60 |
| Max. Negotiated Rate |
$19,841.55 |
| Rate for Payer: Adventist Health Commercial |
$4,668.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cash Price |
$12,838.65
|
| Rate for Payer: Cigna of CA HMO |
$16,340.10
|
| Rate for Payer: Cigna of CA PPO |
$16,340.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,337.20
|
| Rate for Payer: EPIC Health Plan Senior |
$9,337.20
|
| Rate for Payer: Galaxy Health WC |
$19,841.55
|
| Rate for Payer: Global Benefits Group Commercial |
$14,005.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,569.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,893.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,449.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,602.32
|
| Rate for Payer: Multiplan Commercial |
$18,674.40
|
| Rate for Payer: Networks By Design Commercial |
$11,671.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,841.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,760.63
|
| Rate for Payer: United Healthcare All Other HMO |
$8,527.20
|
| Rate for Payer: United Healthcare HMO Rider |
$8,342.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,644.83
|
|
|
HC EDI CATH 12FRX125CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$479.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 12FRX125CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 6FRX49CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$479.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 6FRX49CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 6FRX50CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC EDI CATH 6FRX50CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$479.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 8FRX100CM
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
900800872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$511.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$429.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$585.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$479.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna of CA HMO |
$499.20
|
| Rate for Payer: Cigna of CA PPO |
$577.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$663.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$663.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$663.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$546.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$468.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$390.00
|
| Rate for Payer: United Healthcare HMO Rider |
$390.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$390.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$663.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$663.00
|
| Rate for Payer: Vantage Medical Group Senior |
$663.00
|
|
|
HC EDI CATH 8FRX100CM
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
900800872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Adventist Health Commercial |
$156.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$312.00
|
| Rate for Payer: Galaxy Health WC |
$663.00
|
| Rate for Payer: Global Benefits Group Commercial |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$520.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: Networks By Design Commercial |
$507.00
|
| Rate for Payer: Prime Health Services Commercial |
$663.00
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
915356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$900.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$900.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,715.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.48
|
| Rate for Payer: Multiplan Commercial |
$3,601.60
|
| Rate for Payer: Networks By Design Commercial |
$2,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
IP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
905356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$900.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$900.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,715.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.48
|
| Rate for Payer: Multiplan Commercial |
$3,601.60
|
| Rate for Payer: Networks By Design Commercial |
$2,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
905356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.48 |
| Max. Negotiated Rate |
$3,826.70 |
| Rate for Payer: Adventist Health Commercial |
$1,845.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,476.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,376.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,607.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,322.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,187.97
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,826.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,826.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,499.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,827.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,151.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,151.40
|
| Rate for Payer: Multiplan Commercial |
$3,601.60
|
| Rate for Payer: Networks By Design Commercial |
$2,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,701.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,701.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,826.70
|
|
|
HC ED MOLD SKT EXP INTERF FLEX HI
|
Facility
|
OP
|
$4,502.00
|
|
|
Service Code
|
CPT L6055
|
| Hospital Charge Code |
915356055
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.48 |
| Max. Negotiated Rate |
$3,826.70 |
| Rate for Payer: Adventist Health Commercial |
$1,845.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,476.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,376.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,607.56
|
| Rate for Payer: Blue Shield of California Commercial |
$3,322.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,187.97
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cash Price |
$2,476.10
|
| Rate for Payer: Cigna of CA HMO |
$3,151.40
|
| Rate for Payer: Cigna of CA PPO |
$3,151.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,826.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,826.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,499.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,827.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,786.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,080.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,151.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,151.40
|
| Rate for Payer: Multiplan Commercial |
$3,601.60
|
| Rate for Payer: Networks By Design Commercial |
$2,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,701.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,701.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,689.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,826.70
|
|
|
HC ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
OP
|
$2,120.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
905356050
|
|
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 |
$1,166.00
|
| Rate for Payer: Cash Price |
$1,166.00
|
| 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 |
$1,354.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,414.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,531.38
|
| 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 ED MOLD SKT FLEX HING TRICEPS
|
Facility
|
IP
|
$4,696.00
|
|
|
Service Code
|
CPT L6050
|
| Hospital Charge Code |
915356050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$939.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$939.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,582.80
|
| Rate for Payer: Cash Price |
$2,582.80
|
| Rate for Payer: Cigna of CA HMO |
$3,287.20
|
| Rate for Payer: Cigna of CA PPO |
$3,287.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,878.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,878.40
|
| Rate for Payer: Galaxy Health WC |
$3,991.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,817.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,132.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,789.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,906.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,127.04
|
| Rate for Payer: Multiplan Commercial |
$3,756.80
|
| Rate for Payer: Networks By Design Commercial |
$2,348.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,991.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,762.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,715.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,678.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,537.94
|
|
