|
HC PARASPINAL UPRIGHTS ADD LE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT L2670
|
| Hospital Charge Code |
905352670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO |
$168.70
|
| Rate for Payer: Cigna of CA PPO |
$168.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.40
|
| Rate for Payer: EPIC Health Plan Senior |
$96.40
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.45
|
| Rate for Payer: United Healthcare All Other HMO |
$88.04
|
| Rate for Payer: United Healthcare HMO Rider |
$86.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.93
|
|
|
HC PARASPINAL UPRIGHTS ADD LE
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT L2670
|
| Hospital Charge Code |
905352670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.84 |
| Max. Negotiated Rate |
$204.85 |
| Rate for Payer: Adventist Health Commercial |
$98.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$204.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$132.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.88
|
| Rate for Payer: Blue Shield of California Commercial |
$185.33
|
| Rate for Payer: Blue Shield of California Commercial |
$122.19
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO |
$168.70
|
| Rate for Payer: Cigna of CA PPO |
$168.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$204.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$204.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$204.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.40
|
| Rate for Payer: EPIC Health Plan Senior |
$96.40
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$168.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$168.70
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Networks By Design Commercial |
$120.50
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$144.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$144.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.45
|
| Rate for Payer: United Healthcare All Other HMO |
$88.04
|
| Rate for Payer: United Healthcare HMO Rider |
$86.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$204.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$204.85
|
| Rate for Payer: Vantage Medical Group Senior |
$204.85
|
|
|
HC PARASPINAL UPRIGHTS ADD LE
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT L2670
|
| Hospital Charge Code |
915352670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$48.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cash Price |
$108.45
|
| Rate for Payer: Cigna of CA HMO |
$168.70
|
| Rate for Payer: Cigna of CA PPO |
$168.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.40
|
| Rate for Payer: EPIC Health Plan Senior |
$96.40
|
| Rate for Payer: Galaxy Health WC |
$204.85
|
| Rate for Payer: Global Benefits Group Commercial |
$144.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.84
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Networks By Design Commercial |
$156.65
|
| Rate for Payer: Prime Health Services Commercial |
$204.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.45
|
| Rate for Payer: United Healthcare All Other HMO |
$88.04
|
| Rate for Payer: United Healthcare HMO Rider |
$86.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.93
|
|
|
HC PARATHYROID
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
909301309
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,133.90 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$787.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC PARATHYROID
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 78071
|
| Hospital Charge Code |
909301309
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$2,078.08 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,078.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$856.03
|
| Rate for Payer: Blue Shield of California Commercial |
$851.09
|
| Rate for Payer: Blue Shield of California Commercial |
$561.61
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$933.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$523.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$847.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$592.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.42
|
| Rate for Payer: United Healthcare All Other HMO |
$824.42
|
| Rate for Payer: United Healthcare HMO Rider |
$824.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
OP
|
$25,018.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819771
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,003.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,054.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cigna of CA HMO |
$16,261.70
|
| Rate for Payer: Cigna of CA PPO |
$18,513.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,512.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$21,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$15,010.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,886.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,004.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$20,014.40
|
| Rate for Payer: Networks By Design Commercial |
$16,261.70
|
| Rate for Payer: Prime Health Services Commercial |
$21,265.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,010.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,010.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
IP
|
$25,018.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819771
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,003.60 |
| Max. Negotiated Rate |
$21,265.30 |
| Rate for Payer: Adventist Health Commercial |
$5,003.60
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,512.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,007.20
|
| Rate for Payer: Galaxy Health WC |
$21,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$15,010.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,886.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14,760.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,004.32
|
| Rate for Payer: Multiplan Commercial |
$20,014.40
|
| Rate for Payer: Networks By Design Commercial |
$16,261.70
|
| Rate for Payer: Prime Health Services Commercial |
$21,265.30
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
905355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$206.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$722.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$608.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.68
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Networks By Design Commercial |
$670.80
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
915355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$877.20 |
| Rate for Payer: Adventist Health Commercial |
$423.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$567.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$774.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$624.67
|
| Rate for Payer: Blue Shield of California Commercial |
$793.61
|
| Rate for Payer: Blue Shield of California Commercial |
$523.22
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$877.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$877.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$877.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$722.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$608.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$722.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$722.40
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Networks By Design Commercial |
$516.00
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$877.20
|
| Rate for Payer: Vantage Medical Group Senior |
$877.20
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
915355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$206.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$722.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$608.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.68
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Networks By Design Commercial |
$670.80
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
905355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$877.20 |
| Rate for Payer: Adventist Health Commercial |
$423.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$567.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$774.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$624.67
|
| Rate for Payer: Blue Shield of California Commercial |
$793.61
|
| Rate for Payer: Blue Shield of California Commercial |
$523.22
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$877.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$877.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$877.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$722.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$655.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$608.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$722.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$722.40
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Networks By Design Commercial |
$516.00
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$877.20
|
| Rate for Payer: Vantage Medical Group Senior |
$877.20
|
|
|
HC PART HAND LITTLE &OR RING FING
|
Facility
|
OP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
915356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$887.76 |
| Max. Negotiated Rate |
$3,144.15 |
| Rate for Payer: Adventist Health Commercial |
$1,516.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,144.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,034.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,774.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,239.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,875.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,844.53
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Cigna of CA HMO |
$2,589.30
|
| Rate for Payer: Cigna of CA PPO |
$2,589.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,144.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,144.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,144.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,589.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,479.60
|
| Rate for Payer: Galaxy Health WC |
$3,144.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,219.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,348.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,342.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,182.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,589.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,589.30
|
| Rate for Payer: Multiplan Commercial |
$2,959.20
|
| Rate for Payer: Networks By Design Commercial |
$1,849.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,144.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,219.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,219.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,388.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,351.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,322.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,211.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,144.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,144.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,144.15
|
|
|
HC PART HAND LITTLE &OR RING FING
|
Facility
|
OP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
905356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$887.76 |
| Max. Negotiated Rate |
$3,144.15 |
| Rate for Payer: Adventist Health Commercial |
$1,516.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,144.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,034.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,774.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,239.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,875.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,844.53
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Cigna of CA HMO |
$2,589.30
|
| Rate for Payer: Cigna of CA PPO |
$2,589.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,144.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,144.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,144.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,589.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,479.60
|
| Rate for Payer: Galaxy Health WC |
$3,144.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,219.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,348.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,342.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,182.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,589.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,589.30
|
| Rate for Payer: Multiplan Commercial |
$2,959.20
|
| Rate for Payer: Networks By Design Commercial |
$1,849.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,144.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,219.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,219.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,388.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,351.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,322.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,211.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,144.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,144.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,144.15
|
|
|
HC PART HAND LITTLE &OR RING FING
|
Facility
|
IP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
905356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$739.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$739.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Cigna of CA HMO |
$2,589.30
|
| Rate for Payer: Cigna of CA PPO |
$2,589.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,589.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,479.60
|
| Rate for Payer: Galaxy Health WC |
$3,144.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,219.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,348.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,182.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.76
|
| Rate for Payer: Multiplan Commercial |
$2,959.20
|
| Rate for Payer: Networks By Design Commercial |
$2,404.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,144.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,388.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,351.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,322.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,211.42
|
|
|
HC PART HAND LITTLE &OR RING FING
|
Facility
|
IP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
915356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$739.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$739.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Cigna of CA HMO |
$2,589.30
|
| Rate for Payer: Cigna of CA PPO |
$2,589.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,589.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,479.60
|
| Rate for Payer: Galaxy Health WC |
$3,144.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,219.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,348.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,182.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.76
|
| Rate for Payer: Multiplan Commercial |
$2,959.20
|
| Rate for Payer: Networks By Design Commercial |
$2,404.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,144.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,388.23
|
| Rate for Payer: United Healthcare All Other HMO |
$1,351.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,322.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,211.42
|
|
|
HC PART HAND REST MULTIPLE FINGER
|
Facility
|
OP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
915356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$753.60 |
| Max. Negotiated Rate |
$2,669.00 |
| Rate for Payer: Adventist Health Commercial |
$1,287.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,669.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,727.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,355.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,900.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2,414.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cigna of CA HMO |
$2,198.00
|
| Rate for Payer: Cigna of CA PPO |
$2,198.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,669.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,669.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,669.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,256.00
|
| Rate for Payer: Galaxy Health WC |
$2,669.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,884.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,049.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,993.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,852.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,198.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: Networks By Design Commercial |
$1,570.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,884.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,147.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1,122.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,028.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,669.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,669.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,669.00
|
|
|
HC PART HAND REST MULTIPLE FINGER
|
Facility
|
OP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
905356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$753.60 |
| Max. Negotiated Rate |
$2,669.00 |
| Rate for Payer: Adventist Health Commercial |
$1,287.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,669.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,727.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,355.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,900.64
|
| Rate for Payer: Blue Shield of California Commercial |
$2,414.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,591.98
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cigna of CA HMO |
$2,198.00
|
| Rate for Payer: Cigna of CA PPO |
$2,198.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,669.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,669.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,669.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,256.00
|
| Rate for Payer: Galaxy Health WC |
$2,669.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,884.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,049.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,993.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,187.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,852.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,198.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: Networks By Design Commercial |
$1,570.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,884.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,147.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1,122.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,028.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,669.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,669.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,669.00
|
|
|
HC PART HAND REST MULTIPLE FINGER
|
Facility
|
IP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
905356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$628.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cigna of CA HMO |
$2,198.00
|
| Rate for Payer: Cigna of CA PPO |
$2,198.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,256.00
|
| Rate for Payer: Galaxy Health WC |
$2,669.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,884.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,993.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,852.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.60
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: Networks By Design Commercial |
$2,041.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,147.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1,122.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,028.35
|
|
|
HC PART HAND REST MULTIPLE FINGER
|
Facility
|
IP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
915356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$628.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cigna of CA HMO |
$2,198.00
|
| Rate for Payer: Cigna of CA PPO |
$2,198.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,256.00
|
| Rate for Payer: Galaxy Health WC |
$2,669.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,884.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,993.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,852.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.60
|
| Rate for Payer: Multiplan Commercial |
$2,512.00
|
| Rate for Payer: Networks By Design Commercial |
$2,041.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,178.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,147.04
|
| Rate for Payer: United Healthcare HMO Rider |
$1,122.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,028.35
|
|
|
HC PART HAND REST NO FING REMAIN
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
905356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cigna of CA HMO |
$2,141.30
|
| Rate for Payer: Cigna of CA PPO |
$2,141.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,223.60
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,942.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,804.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.16
|
| Rate for Payer: Multiplan Commercial |
$2,447.20
|
| Rate for Payer: Networks By Design Commercial |
$1,988.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,148.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1,117.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,001.82
|
|
|
HC PART HAND REST NO FING REMAIN
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
915356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$734.16 |
| Max. Negotiated Rate |
$2,600.15 |
| Rate for Payer: Cigna of CA HMO |
$2,141.30
|
| Rate for Payer: Cigna of CA PPO |
$2,141.30
|
| Rate for Payer: Adventist Health Commercial |
$1,254.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,682.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,294.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,851.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,352.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,550.91
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,600.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,600.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,223.60
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,089.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,942.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,232.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,804.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,141.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,447.20
|
| Rate for Payer: Networks By Design Commercial |
$1,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,835.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,835.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,148.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1,117.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,001.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,600.15
|
|
|
HC PART HAND REST NO FING REMAIN
|
Facility
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
915356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cigna of CA HMO |
$2,141.30
|
| Rate for Payer: Cigna of CA PPO |
$2,141.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,223.60
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,942.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,804.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.16
|
| Rate for Payer: Multiplan Commercial |
$2,447.20
|
| Rate for Payer: Networks By Design Commercial |
$1,988.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,148.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1,117.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,001.82
|
|
|
HC PART HAND REST NO FING REMAIN
|
Facility
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
905356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$734.16 |
| Max. Negotiated Rate |
$2,600.15 |
| Rate for Payer: Adventist Health Commercial |
$1,254.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,682.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,294.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,851.61
|
| Rate for Payer: Blue Shield of California Commercial |
$2,352.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,550.91
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cigna of CA HMO |
$2,141.30
|
| Rate for Payer: Cigna of CA PPO |
$2,141.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,600.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,600.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,223.60
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,089.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,942.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,232.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,804.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,141.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,447.20
|
| Rate for Payer: Networks By Design Commercial |
$1,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,835.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,835.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,148.04
|
| Rate for Payer: United Healthcare All Other HMO |
$1,117.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,001.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,600.15
|
|
|
HC PART HAND REST REPLACEMT GLOVE
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT L6915
|
| Hospital Charge Code |
915356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$309.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$309.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna of CA HMO |
$1,084.30
|
| Rate for Payer: Cigna of CA PPO |
$1,084.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$619.60
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$983.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Multiplan Commercial |
$1,239.20
|
| Rate for Payer: Networks By Design Commercial |
$1,006.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.34
|
| Rate for Payer: United Healthcare All Other HMO |
$565.85
|
| Rate for Payer: United Healthcare HMO Rider |
$553.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.30
|
|
|
HC PART HAND REST REPLACEMT GLOVE
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT L6915
|
| Hospital Charge Code |
915356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$371.76 |
| Max. Negotiated Rate |
$1,316.65 |
| Rate for Payer: Adventist Health Commercial |
$635.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,316.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$851.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,161.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$937.61
|
| Rate for Payer: Blue Shield of California Commercial |
$785.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.18
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna of CA HMO |
$1,084.30
|
| Rate for Payer: Cigna of CA PPO |
$1,084.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,316.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,316.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,316.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$619.60
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$701.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$983.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$792.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,084.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,084.30
|
| Rate for Payer: Multiplan Commercial |
$1,239.20
|
| Rate for Payer: Networks By Design Commercial |
$774.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$929.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$929.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.34
|
| Rate for Payer: United Healthcare All Other HMO |
$565.85
|
| Rate for Payer: United Healthcare HMO Rider |
$553.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,316.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,316.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,316.65
|
|
