|
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 |
$3,329.10 |
| Rate for Payer: Adventist Health Commercial |
$739.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,966.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,864.30
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,959.20
|
| 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: Health Management Network EPO/PPO |
$3,329.10
|
| 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 |
$739.80
|
| Rate for Payer: Multiplan Commercial |
$2,774.25
|
| 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
|
OP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
915356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,211.42 |
| Max. Negotiated Rate |
$3,329.10 |
| 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 |
$2,151.71
|
| Rate for Payer: Blue Shield of California Commercial |
$2,966.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,864.30
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,959.20
|
| 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: Health Management Network EPO/PPO |
$3,329.10
|
| 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 |
$1,516.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,589.30
|
| Rate for Payer: Multiplan Commercial |
$2,774.25
|
| Rate for Payer: Networks By Design Commercial |
$1,849.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,144.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,479.60
|
| 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 REST MULTIPLE FINGER
|
Facility
|
OP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
915356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.35 |
| Max. Negotiated Rate |
$2,826.00 |
| 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 |
$1,826.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,518.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,582.56
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,512.00
|
| 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: Health Management Network EPO/PPO |
$2,826.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,074.81
|
| 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 |
$1,287.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| Rate for Payer: Networks By Design Commercial |
$1,570.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.00
|
| 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 |
915356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.00 |
| Max. Negotiated Rate |
$2,826.00 |
| Rate for Payer: United Healthcare HMO Rider |
$1,122.24
|
| Rate for Payer: Adventist Health Commercial |
$628.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,518.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,582.56
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,512.00
|
| 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: Health Management Network EPO/PPO |
$2,826.00
|
| 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 |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| 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 Select/Navigate/Core |
$1,028.35
|
|
|
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 |
$2,826.00 |
| Rate for Payer: Adventist Health Commercial |
$628.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,518.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,582.56
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,512.00
|
| 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: Health Management Network EPO/PPO |
$2,826.00
|
| 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 |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| 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
|
OP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
905356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.35 |
| Max. Negotiated Rate |
$2,826.00 |
| 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 |
$1,826.54
|
| Rate for Payer: Blue Shield of California Commercial |
$2,518.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,582.56
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,512.00
|
| 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: Health Management Network EPO/PPO |
$2,826.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,074.81
|
| 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 |
$1,287.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| Rate for Payer: Networks By Design Commercial |
$1,570.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.00
|
| 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 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 |
$2,753.10 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,541.74
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| 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: Health Management Network EPO/PPO |
$2,753.10
|
| 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 |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| 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
|
IP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
905356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.80 |
| Max. Negotiated Rate |
$2,753.10 |
| Rate for Payer: Adventist Health Commercial |
$611.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,541.74
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| 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: Health Management Network EPO/PPO |
$2,753.10
|
| 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 |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| 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 |
$1,001.82 |
| Max. Negotiated Rate |
$2,753.10 |
| Rate for Payer: Dignity Health Medi-Cal |
$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 |
$1,779.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,541.74
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| 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 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: Health Management Network EPO/PPO |
$2,753.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,115.39
|
| 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 |
$1,254.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: Networks By Design Commercial |
$1,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,223.60
|
| 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
|
OP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
905356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,001.82 |
| Max. Negotiated Rate |
$2,753.10 |
| 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 |
$1,779.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,453.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,541.74
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| 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: Health Management Network EPO/PPO |
$2,753.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,115.39
|
| 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 |
$1,254.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: Networks By Design Commercial |
$1,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,223.60
|
| 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 |
$1,394.10 |
| Rate for Payer: Adventist Health Commercial |
$309.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.30
|
| Rate for Payer: Blue Shield of California EPN |
$780.70
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,239.20
|
| 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: Health Management Network EPO/PPO |
$1,394.10
|
| 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 |
$309.80
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| 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 |
905356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$507.30 |
| Max. Negotiated Rate |
$1,394.10 |
| 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 |
$901.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.30
|
| Rate for Payer: Blue Shield of California EPN |
$780.70
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,239.20
|
| 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: Health Management Network EPO/PPO |
$1,394.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$717.76
|
| 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 |
$635.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,084.30
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| Rate for Payer: Networks By Design Commercial |
$774.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: Riverside University Health System MISP |
$619.60
|
| 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
|
|
|
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 |
$507.30 |
| Max. Negotiated Rate |
$1,394.10 |
| Rate for Payer: Networks By Design Commercial |
$774.50
|
| 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 |
$901.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.30
|
| Rate for Payer: Blue Shield of California EPN |
$780.70
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,239.20
|
| 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: Health Management Network EPO/PPO |
$1,394.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$717.76
|
| 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 |
$635.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,084.30
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: Riverside University Health System MISP |
$619.60
|
| 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
|
|
|
HC PART HAND REST REPLACEMT GLOVE
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT L6915
|
| Hospital Charge Code |
905356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$309.80 |
| Max. Negotiated Rate |
$1,394.10 |
| Rate for Payer: Adventist Health Commercial |
$309.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.30
|
| Rate for Payer: Blue Shield of California EPN |
$780.70
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,239.20
|
| 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: Health Management Network EPO/PPO |
$1,394.10
|
| 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 |
$309.80
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| 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 W/GLOVE THMB
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
915356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,053.89 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Adventist Health Commercial |
$1,319.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,769.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,413.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,871.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,580.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,621.87
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,574.40
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,735.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,735.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,896.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,126.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,244.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,319.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,252.60
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$1,609.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,287.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,207.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1,175.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,735.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,735.30
|
|
|
HC PART HAND REST W/GLOVE THMB
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
905356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,053.89 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Adventist Health Commercial |
$1,319.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,769.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,413.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,871.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,580.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,621.87
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,574.40
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,735.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,735.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,896.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,126.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,244.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,319.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,252.60
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$1,609.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,287.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,207.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1,175.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,735.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,735.30
|
|
|
HC PART HAND REST W/GLOVE THMB
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
915356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,580.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,621.87
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,574.40
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,896.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.60
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,207.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1,175.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.89
|
|
|
HC PART HAND REST W/GLOVE THMB
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
905356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,580.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,621.87
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,574.40
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,896.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.60
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,207.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1,175.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.89
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,117.60 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$2,117.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,411.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,235.20
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,723.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,246.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$4,341.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,314.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: Cigna of CA HMO |
$6,776.32
|
| Rate for Payer: Cigna of CA PPO |
$7,835.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,411.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,723.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,352.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,352.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$2,117.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: Cigna of CA HMO |
$6,776.32
|
| Rate for Payer: Cigna of CA PPO |
$7,835.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,411.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,723.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,352.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,294.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,294.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,294.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,294.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,117.60 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$2,117.60
|
| Rate for Payer: Cash Price |
$4,764.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,411.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,235.20
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,723.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,246.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
915356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,110.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,954.51
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,490.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,462.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.60
|
| Rate for Payer: Multiplan Commercial |
$2,908.50
|
| Rate for Payer: Networks By Design Commercial |
$2,520.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
OP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
905356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.05 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Adventist Health Commercial |
$1,589.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,132.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,908.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,255.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,110.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,954.51
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,296.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,296.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,490.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,462.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,407.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,714.60
|
| Rate for Payer: Multiplan Commercial |
$2,908.50
|
| Rate for Payer: Networks By Design Commercial |
$1,939.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,551.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,326.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,326.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,296.30
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
905356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,110.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,954.51
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,490.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,462.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.60
|
| Rate for Payer: Multiplan Commercial |
$2,908.50
|
| Rate for Payer: Networks By Design Commercial |
$2,520.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
|
