|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,178.64 |
| Max. Negotiated Rate |
$4,174.35 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,844.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,624.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,386.75
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,123.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,437.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$950.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$950.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
915351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$707.76 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Adventist Health Commercial |
$1,209.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,211.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,708.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,176.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.21
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,506.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,378.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,064.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,064.30
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,506.65
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
915351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
905351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$707.76 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Adventist Health Commercial |
$1,209.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,211.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,708.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,176.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.21
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,506.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,378.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,064.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,064.30
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,506.65
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
905351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
915351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.08 |
| Max. Negotiated Rate |
$1,572.54 |
| Rate for Payer: Adventist Health Commercial |
$703.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.15
|
| Rate for Payer: Blue Shield of California EPN |
$834.46
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,390.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,572.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
915351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.08 |
| Max. Negotiated Rate |
$1,572.54 |
| Rate for Payer: Adventist Health Commercial |
$703.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$994.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.15
|
| Rate for Payer: Blue Shield of California EPN |
$834.46
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,390.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,572.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,373.60
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
915351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$931.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,774.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
915351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,117.68 |
| Max. Negotiated Rate |
$3,958.45 |
| Rate for Payer: Adventist Health Commercial |
$1,909.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,561.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,697.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,436.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,263.30
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,958.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,958.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,429.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,616.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.90
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,794.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,794.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,958.45
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$931.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,774.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,117.68 |
| Max. Negotiated Rate |
$3,958.45 |
| Rate for Payer: Adventist Health Commercial |
$1,909.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,561.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,697.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,436.87
|
| Rate for Payer: Blue Shield of California EPN |
$2,263.30
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,958.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,958.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,429.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,616.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,882.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,117.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,259.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,259.90
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,794.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,794.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,747.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,701.20
|
| Rate for Payer: United Healthcare HMO Rider |
$1,664.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,958.45
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
915352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
915352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$223.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
IP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
915355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,933.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Adventist Health Commercial |
$1,933.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,683.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
OP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,320.08 |
| Max. Negotiated Rate |
$8,216.95 |
| Rate for Payer: Adventist Health Commercial |
$3,963.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,316.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,599.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,134.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,698.16
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,216.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,216.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,280.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,971.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,766.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,766.90
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,216.95
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
OP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
915355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,320.08 |
| Max. Negotiated Rate |
$8,216.95 |
| Rate for Payer: Adventist Health Commercial |
$3,963.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,316.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,599.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,134.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,698.16
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,216.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,216.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,280.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,971.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,766.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,766.90
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,216.95
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
IP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,933.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,933.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,683.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,983.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,320.08
|
| Rate for Payer: Multiplan Commercial |
$7,733.60
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,628.03
|
| Rate for Payer: United Healthcare All Other HMO |
$3,531.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3,454.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,165.94
|
|
