|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
915352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.68 |
| Max. Negotiated Rate |
$622.20 |
| Rate for Payer: Adventist Health Commercial |
$300.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$402.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$423.97
|
| Rate for Payer: Blue Shield of California Commercial |
$540.22
|
| Rate for Payer: Blue Shield of California EPN |
$355.75
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$622.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$622.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$622.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$265.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$512.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$512.40
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$439.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$439.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$622.20
|
| Rate for Payer: Vantage Medical Group Senior |
$622.20
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
905352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.68 |
| Max. Negotiated Rate |
$622.20 |
| Rate for Payer: Adventist Health Commercial |
$300.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$402.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$549.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$423.97
|
| Rate for Payer: Blue Shield of California Commercial |
$540.22
|
| Rate for Payer: Blue Shield of California EPN |
$355.75
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$622.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$622.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$622.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$265.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$512.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$512.40
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$439.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$439.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$622.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$622.20
|
| Rate for Payer: Vantage Medical Group Senior |
$622.20
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
915352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
|
|
HC ISCHEAL RING ADD. TO KAFO
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT L2500
|
| Hospital Charge Code |
905352500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$146.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna of CA HMO |
$512.40
|
| Rate for Payer: Cigna of CA PPO |
$512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.80
|
| Rate for Payer: EPIC Health Plan Senior |
$292.80
|
| Rate for Payer: Galaxy Health WC |
$622.20
|
| Rate for Payer: Global Benefits Group Commercial |
$439.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$488.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.68
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Networks By Design Commercial |
$366.00
|
| Rate for Payer: Prime Health Services Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$274.72
|
| Rate for Payer: United Healthcare All Other HMO |
$267.40
|
| Rate for Payer: United Healthcare HMO Rider |
$261.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.73
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$232.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.01
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: Cigna of CA HMO |
$227.20
|
| Rate for Payer: Cigna of CA PPO |
$262.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.35
|
| Rate for Payer: EPIC Health Plan Senior |
$12.11
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.23
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.32
|
| Rate for Payer: Vantage Medical Group Senior |
$12.11
|
|
|
HC ISOHEMAGGLUTININ TITER
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 86941
|
| Hospital Charge Code |
900904760
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$71.00 |
| Max. Negotiated Rate |
$301.75 |
| Rate for Payer: Adventist Health Commercial |
$71.00
|
| Rate for Payer: Cash Price |
$195.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.00
|
| Rate for Payer: EPIC Health Plan Senior |
$142.00
|
| Rate for Payer: Galaxy Health WC |
$301.75
|
| Rate for Payer: Global Benefits Group Commercial |
$213.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$236.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$219.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.20
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: Networks By Design Commercial |
$230.75
|
| Rate for Payer: Prime Health Services Commercial |
$301.75
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
905356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
915356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
915356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$596.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,091.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$842.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,073.79
|
| Rate for Payer: Blue Shield of California EPN |
$707.13
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,236.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$638.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,018.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,018.50
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.75
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
905356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$349.20 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$596.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,091.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$842.74
|
| Rate for Payer: Blue Shield of California Commercial |
$1,073.79
|
| Rate for Payer: Blue Shield of California EPN |
$707.13
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cash Price |
$800.25
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,236.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$638.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,018.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,018.50
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.75
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
OP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
915356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,788.80 |
| Max. Negotiated Rate |
$9,877.00 |
| Rate for Payer: Adventist Health Commercial |
$4,764.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,391.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,715.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,730.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8,575.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,647.32
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,877.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,877.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,968.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,750.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,487.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,192.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,134.00
|
| Rate for Payer: Multiplan Commercial |
$9,296.00
|
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,877.00
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
OP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
905356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,788.80 |
| Max. Negotiated Rate |
$9,877.00 |
| Rate for Payer: Adventist Health Commercial |
$4,764.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,391.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,715.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,730.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8,575.56
|
| Rate for Payer: Blue Shield of California EPN |
$5,647.32
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,877.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,877.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,968.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,750.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,487.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,192.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,134.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,134.00
|
| Rate for Payer: Multiplan Commercial |
$9,296.00
|
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,877.00
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
IP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
905356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,324.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,750.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,427.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,192.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Multiplan Commercial |
$9,296.00
|
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
IP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
915356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,324.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cash Price |
$6,391.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,750.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,427.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,192.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Multiplan Commercial |
$9,296.00
|
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
IP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
905356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,832.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,832.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,490.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,670.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.64
|
| Rate for Payer: Multiplan Commercial |
$7,328.80
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
OP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
905356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,198.64 |
| Max. Negotiated Rate |
$7,786.85 |
| Rate for Payer: Adventist Health Commercial |
$3,756.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,038.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,870.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,306.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6,760.82
|
| Rate for Payer: Blue Shield of California EPN |
$4,452.25
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,786.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,786.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,605.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,339.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,670.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,412.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,412.70
|
| Rate for Payer: Multiplan Commercial |
$7,328.80
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,496.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,496.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,786.85
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
OP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
915356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,198.64 |
| Max. Negotiated Rate |
$7,786.85 |
| Rate for Payer: Adventist Health Commercial |
$3,756.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,038.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,870.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,306.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6,760.82
|
| Rate for Payer: Blue Shield of California EPN |
$4,452.25
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,786.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,786.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,605.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,339.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,670.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,412.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,412.70
|
| Rate for Payer: Multiplan Commercial |
$7,328.80
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,496.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,496.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,786.85
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
IP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
915356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,832.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,832.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cash Price |
$5,038.55
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,110.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,490.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,670.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,198.64
|
| Rate for Payer: Multiplan Commercial |
$7,328.80
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
IP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,333.80 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$9,333.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,780.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
OP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,200.56 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$19,134.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,667.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,030.68
|
| Rate for Payer: Blue Shield of California Commercial |
$34,441.72
|
| Rate for Payer: Blue Shield of California EPN |
$22,681.13
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,668.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,295.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,668.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,668.30
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,001.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Senior |
$39,668.65
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
OP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
915356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,200.56 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$19,134.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,667.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,030.68
|
| Rate for Payer: Blue Shield of California Commercial |
$34,441.72
|
| Rate for Payer: Blue Shield of California EPN |
$22,681.13
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,668.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,295.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32,668.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32,668.30
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,001.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Senior |
$39,668.65
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
IP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
915356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,333.80 |
| Max. Negotiated Rate |
$39,668.65 |
| Rate for Payer: Adventist Health Commercial |
$9,333.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cash Price |
$25,667.95
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,128.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,780.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,888.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,200.56
|
| Rate for Payer: Multiplan Commercial |
$37,335.20
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
IP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
915356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,502.80 |
| Max. Negotiated Rate |
$31,886.90 |
| Rate for Payer: Adventist Health Commercial |
$7,502.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$20,632.70
|
| Rate for Payer: Cash Price |
$20,632.70
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,292.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,221.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,003.36
|
| Rate for Payer: Multiplan Commercial |
$30,011.20
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
IP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
905356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,502.80 |
| Max. Negotiated Rate |
$31,886.90 |
| Rate for Payer: Adventist Health Commercial |
$7,502.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$20,632.70
|
| Rate for Payer: Cash Price |
$20,632.70
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,292.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,221.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,003.36
|
| Rate for Payer: Multiplan Commercial |
$30,011.20
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
OP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
915356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,003.36 |
| Max. Negotiated Rate |
$31,886.90 |
| Rate for Payer: Adventist Health Commercial |
$15,380.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,632.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,135.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,728.11
|
| Rate for Payer: Blue Shield of California Commercial |
$27,685.33
|
| Rate for Payer: Blue Shield of California EPN |
$18,231.80
|
| Rate for Payer: Cash Price |
$20,632.70
|
| Rate for Payer: Cash Price |
$20,632.70
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,886.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,886.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,877.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,433.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,221.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,003.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,259.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,259.80
|
| Rate for Payer: Multiplan Commercial |
$30,011.20
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,508.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Senior |
$31,886.90
|
|
