|
HC KAFO SNG/DBL MECHANICAL ACT
|
Facility
|
OP
|
$5,656.00
|
|
|
Service Code
|
CPT L2005
|
| Hospital Charge Code |
915352005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,357.44 |
| Max. Negotiated Rate |
$4,894.13 |
| Rate for Payer: Adventist Health Commercial |
$2,318.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,110.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,242.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,423.58
|
| Rate for Payer: Blue Shield of California Commercial |
$4,349.46
|
| Rate for Payer: Blue Shield of California Commercial |
$2,867.59
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Cash Price |
$2,545.20
|
| Rate for Payer: Cigna of CA HMO |
$3,959.20
|
| Rate for Payer: Cigna of CA PPO |
$3,959.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,807.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,807.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,959.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,262.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,262.40
|
| Rate for Payer: Galaxy Health WC |
$4,807.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,393.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,327.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,591.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,894.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,337.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,357.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,959.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,959.20
|
| Rate for Payer: Multiplan Commercial |
$4,524.80
|
| Rate for Payer: Networks By Design Commercial |
$2,828.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,807.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,393.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,122.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2,066.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,021.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,852.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,807.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4,807.60
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: Adventist Health Commercial |
$111.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.64
|
| Rate for Payer: Blue Shield of California Commercial |
$209.17
|
| Rate for Payer: Blue Shield of California Commercial |
$137.90
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.28 |
| Max. Negotiated Rate |
$231.20 |
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Adventist Health Commercial |
$111.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.64
|
| Rate for Payer: Blue Shield of California Commercial |
$209.17
|
| Rate for Payer: Blue Shield of California Commercial |
$137.90
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
905352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$172.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$160.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.28
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.64 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.37
|
| Rate for Payer: Blue Shield of California Commercial |
$546.76
|
| Rate for Payer: Blue Shield of California Commercial |
$360.48
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$676.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.64 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.37
|
| Rate for Payer: Blue Shield of California Commercial |
$546.76
|
| Rate for Payer: Blue Shield of California Commercial |
$360.48
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$676.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$451.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$419.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.64
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.93 |
| Max. Negotiated Rate |
$1,057.40 |
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$752.99
|
| Rate for Payer: Blue Shield of California Commercial |
$956.64
|
| Rate for Payer: Blue Shield of California Commercial |
$630.71
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$870.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.93 |
| Max. Negotiated Rate |
$1,057.40 |
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$752.99
|
| Rate for Payer: Blue Shield of California Commercial |
$956.64
|
| Rate for Payer: Blue Shield of California Commercial |
$630.71
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$789.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$733.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$298.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$870.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.50
|
| Rate for Payer: Blue Shield of California Commercial |
$536.76
|
| Rate for Payer: Blue Shield of California Commercial |
$353.89
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$251.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.50
|
| Rate for Payer: Blue Shield of California Commercial |
$536.76
|
| Rate for Payer: Blue Shield of California Commercial |
$353.89
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$251.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
915355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
915355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.16 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$580.48
|
| Rate for Payer: Blue Shield of California Commercial |
$737.47
|
| Rate for Payer: Blue Shield of California Commercial |
$486.21
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.16 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$580.48
|
| Rate for Payer: Blue Shield of California Commercial |
$737.47
|
| Rate for Payer: Blue Shield of California Commercial |
$486.21
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
OP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
915355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,298.56 |
| Max. Negotiated Rate |
$12,750.85 |
| Rate for Payer: Adventist Health Commercial |
$6,150.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,080.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7,605.51
|
| Rate for Payer: Blue Shield of California Commercial |
$11,535.77
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,298.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.70
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.85
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
OP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,298.56 |
| Max. Negotiated Rate |
$12,750.85 |
| Rate for Payer: Adventist Health Commercial |
$6,150.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,080.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7,605.51
|
| Rate for Payer: Blue Shield of California Commercial |
$11,535.77
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,298.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.70
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.85
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
IP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
915355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$9,750.65
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
IP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$9,750.65
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
|
