|
HC PROSTH ADD SHOULDER HAMESS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
915355699
|
|
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 |
$211.85
|
| Rate for Payer: Blue Shield of California Commercial |
$269.15
|
| Rate for Payer: Blue Shield of California Commercial |
$177.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$243.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 PROSTHETIC NIPPLE-CUSTOM FIT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC PROSTHETIC NIPPLE-CUSTOM FIT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC PROSTHETIC NIPPLE-CUSTOM FIT
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.13
|
| Rate for Payer: Blue Shield of California Commercial |
$12.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.23
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC PROSTHETIC NIPPLE-CUSTOM FIT
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC PROSTHETIC NIPPLE-CUSTOM MADE
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC PROSTHETIC NIPPLE-CUSTOM MADE
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.60
|
| Rate for Payer: Blue Shield of California Commercial |
$248.43
|
| Rate for Payer: Blue Shield of California Commercial |
$376.81
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC PROSTHETIC NIPPLE-CUSTOM MADE
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.60
|
| Rate for Payer: Blue Shield of California Commercial |
$248.43
|
| Rate for Payer: Blue Shield of California Commercial |
$376.81
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$177.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC PROSTHETIC NIPPLE-CUSTOM MADE
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$311.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$289.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
905358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
915358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
915358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
905358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC PROSTHETIC SHEATH BK EACH
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
915358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$36.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.48
|
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California Commercial |
$45.63
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC PROSTHETIC SHEATH BK EACH
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
915358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
HC PROSTHETIC SHEATH BK EACH
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
905358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
|
|
HC PROSTHETIC SHEATH BK EACH
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
905358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.96 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$36.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.48
|
| Rate for Payer: Blue Shield of California Commercial |
$69.21
|
| Rate for Payer: Blue Shield of California Commercial |
$45.63
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC PROSTHETIC SHEATH WOOL BK EACH
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT L8420
|
| Hospital Charge Code |
905358420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$82.60
|
| Rate for Payer: Cigna of CA PPO |
$82.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Senior |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$76.70
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.29
|
| Rate for Payer: United Healthcare All Other HMO |
$43.11
|
| Rate for Payer: United Healthcare HMO Rider |
$42.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.65
|
|
|
HC PROSTHETIC SHEATH WOOL BK EACH
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L8420
|
| Hospital Charge Code |
915358420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC PROSTHETIC SHEATH WOOL BK EACH
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT L8420
|
| Hospital Charge Code |
905358420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$100.30 |
| Rate for Payer: Adventist Health Commercial |
$48.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.43
|
| Rate for Payer: Blue Shield of California Commercial |
$90.74
|
| Rate for Payer: Blue Shield of California Commercial |
$59.83
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO |
$82.60
|
| Rate for Payer: Cigna of CA PPO |
$82.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$82.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Senior |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$82.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$82.60
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Networks By Design Commercial |
$59.00
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.29
|
| Rate for Payer: United Healthcare All Other HMO |
$43.11
|
| Rate for Payer: United Healthcare HMO Rider |
$42.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC PROSTHETIC SHEATH WOOL BK EACH
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L8420
|
| Hospital Charge Code |
915358420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.72
|
| Rate for Payer: Blue Shield of California Commercial |
$68.44
|
| Rate for Payer: Blue Shield of California Commercial |
$103.81
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC PROSTHETIC SHRINKER AK EACH
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT L8460
|
| Hospital Charge Code |
905358460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$187.00 |
| Rate for Payer: Adventist Health Commercial |
$90.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.17
|
| Rate for Payer: Blue Shield of California Commercial |
$169.18
|
| Rate for Payer: Blue Shield of California Commercial |
$111.54
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna of CA HMO |
$154.00
|
| Rate for Payer: Cigna of CA PPO |
$154.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Networks By Design Commercial |
$110.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.57
|
| Rate for Payer: United Healthcare All Other HMO |
$80.37
|
| Rate for Payer: United Healthcare HMO Rider |
$78.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.00
|
| Rate for Payer: Vantage Medical Group Senior |
$187.00
|
|
|
HC PROSTHETIC SHRINKER AK EACH
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT L8460
|
| Hospital Charge Code |
905358460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna of CA HMO |
$154.00
|
| Rate for Payer: Cigna of CA PPO |
$154.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.57
|
| Rate for Payer: United Healthcare All Other HMO |
$80.37
|
| Rate for Payer: United Healthcare HMO Rider |
$78.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.05
|
|
|
HC PROSTHETIC SHRINKER AK EACH
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT L8460
|
| Hospital Charge Code |
915358460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
|
|
HC PROSTHETIC SHRINKER AK EACH
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT L8460
|
| Hospital Charge Code |
915358460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$213.35 |
| Rate for Payer: Adventist Health Commercial |
$102.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.93
|
| Rate for Payer: Blue Shield of California Commercial |
$193.02
|
| Rate for Payer: Blue Shield of California Commercial |
$127.26
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cigna of CA HMO |
$175.70
|
| Rate for Payer: Cigna of CA PPO |
$175.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.70
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Networks By Design Commercial |
$125.50
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$94.20
|
| Rate for Payer: United Healthcare All Other HMO |
$91.69
|
| Rate for Payer: United Healthcare HMO Rider |
$89.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.35
|
| Rate for Payer: Vantage Medical Group Senior |
$213.35
|
|
