|
HC PARATHYROID WITH PLANAR
|
Facility
|
OP
|
$2,197.00
|
|
|
Service Code
|
CPT 78072
|
| Hospital Charge Code |
900078072
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$439.40 |
| Max. Negotiated Rate |
$1,977.30 |
| Rate for Payer: Adventist Health Commercial |
$439.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,334.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,943.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,290.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,333.58
|
| Rate for Payer: Blue Shield of California EPN |
$872.21
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Cash Price |
$988.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,757.60
|
| Rate for Payer: Cigna of CA HMO |
$1,406.08
|
| Rate for Payer: Cigna of CA PPO |
$1,625.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$1,867.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,318.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,977.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$627.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,465.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$693.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$1,647.75
|
| Rate for Payer: Networks By Design Commercial |
$1,428.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,867.45
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,318.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,318.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.42
|
| Rate for Payer: United Healthcare All Other HMO |
$824.42
|
| Rate for Payer: United Healthcare HMO Rider |
$824.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
OP
|
$25,018.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819771
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,003.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,113.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,693.07
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Central Health Plan Commercial |
$20,014.40
|
| Rate for Payer: Cigna of CA HMO |
$16,261.70
|
| Rate for Payer: Cigna of CA PPO |
$18,513.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$21,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$15,010.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,516.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,687.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,003.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$18,763.50
|
| Rate for Payer: Networks By Design Commercial |
$16,261.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$21,265.30
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,010.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,010.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
IP
|
$21,755.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,351.00 |
| Max. Negotiated Rate |
$19,579.50 |
| Rate for Payer: Adventist Health Commercial |
$4,351.00
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: Central Health Plan Commercial |
$17,404.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,702.00
|
| Rate for Payer: Galaxy Health WC |
$18,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,579.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,510.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,288.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,466.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,351.00
|
| Rate for Payer: Multiplan Commercial |
$16,316.25
|
| Rate for Payer: Networks By Design Commercial |
$14,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$18,491.75
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
IP
|
$25,018.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906819771
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,003.60 |
| Max. Negotiated Rate |
$22,516.20 |
| Rate for Payer: Adventist Health Commercial |
$5,003.60
|
| Rate for Payer: Cash Price |
$11,258.10
|
| Rate for Payer: Central Health Plan Commercial |
$20,014.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,007.20
|
| Rate for Payer: Galaxy Health WC |
$21,265.30
|
| Rate for Payer: Global Benefits Group Commercial |
$15,010.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,516.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,687.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,531.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,486.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,003.60
|
| Rate for Payer: Multiplan Commercial |
$18,763.50
|
| Rate for Payer: Networks By Design Commercial |
$16,261.70
|
| Rate for Payer: Prime Health Services Commercial |
$21,265.30
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
|
OP
|
$21,755.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,351.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,533.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,776.71
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: Cash Price |
$9,789.75
|
| Rate for Payer: Central Health Plan Commercial |
$17,404.00
|
| Rate for Payer: Cigna of CA HMO |
$14,140.75
|
| Rate for Payer: Cigna of CA PPO |
$16,098.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$18,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,579.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,510.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,351.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$16,316.25
|
| Rate for Payer: Networks By Design Commercial |
$14,140.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$18,491.75
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC PARENT INFANT GRP OT 60 MIN
|
Facility
|
OP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$193.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$354.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: Cigna of CA HMO |
$302.72
|
| Rate for Payer: Cigna of CA PPO |
$350.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.29
|
| Rate for Payer: InnovAge PACE Commercial |
$236.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.10
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
| Rate for Payer: Riverside University Health System MISP |
$189.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$283.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$283.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.05
|
| Rate for Payer: Vantage Medical Group Senior |
$402.05
|
|
|
HC PARENT INFANT GRP OT 60 MIN
|
Facility
|
IP
|
$473.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$425.70 |
| Rate for Payer: Adventist Health Commercial |
$94.60
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Central Health Plan Commercial |
$378.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.20
|
| Rate for Payer: EPIC Health Plan Senior |
$189.20
|
| Rate for Payer: Galaxy Health WC |
$402.05
|
| Rate for Payer: Global Benefits Group Commercial |
$283.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$425.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$292.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.60
|
| Rate for Payer: Multiplan Commercial |
$354.75
|
| Rate for Payer: Networks By Design Commercial |
$307.45
|
| Rate for Payer: Prime Health Services Commercial |
$402.05
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
905355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.17 |
| Max. Negotiated Rate |
$928.80 |
| Rate for Payer: Adventist Health Commercial |
$423.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$567.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$774.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.09
|
| Rate for Payer: Blue Shield of California Commercial |
$797.74
|
| Rate for Payer: Blue Shield of California EPN |
$520.13
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Central Health Plan Commercial |
$825.60
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$877.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$877.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$877.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$928.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.17
|
| Rate for Payer: InnovAge PACE Commercial |
$516.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$722.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$722.40
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$516.00
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: Riverside University Health System MISP |
$412.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$877.20
|
| Rate for Payer: Vantage Medical Group Senior |
$877.20
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
905355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$928.80 |
| Rate for Payer: Adventist Health Commercial |
$206.40
|
| Rate for Payer: Blue Shield of California Commercial |
$797.74
|
| Rate for Payer: Blue Shield of California EPN |
$520.13
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Central Health Plan Commercial |
$825.60
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$928.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.40
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$670.80
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
915355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.17 |
| Max. Negotiated Rate |
$928.80 |
| Rate for Payer: Adventist Health Commercial |
$423.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$567.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$774.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$606.09
|
| Rate for Payer: Blue Shield of California Commercial |
$797.74
|
| Rate for Payer: Blue Shield of California EPN |
$520.13
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Central Health Plan Commercial |
$825.60
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$877.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$877.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$877.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$928.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$336.17
|
| Rate for Payer: InnovAge PACE Commercial |
$516.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$722.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$722.40
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$516.00
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: Riverside University Health System MISP |
$412.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$877.20
|
| Rate for Payer: Vantage Medical Group Senior |
$877.20
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
915355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$928.80 |
| Rate for Payer: Adventist Health Commercial |
$206.40
|
| Rate for Payer: Blue Shield of California Commercial |
$797.74
|
| Rate for Payer: Blue Shield of California EPN |
$520.13
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Central Health Plan Commercial |
$825.60
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Senior |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$928.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$638.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.40
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$670.80
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.31
|
| Rate for Payer: United Healthcare All Other HMO |
$376.99
|
| Rate for Payer: United Healthcare HMO Rider |
$368.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.98
|
|
|
HC PART HAND LITTLE &OR RING FING
|
Facility
|
IP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
905356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$739.80 |
| Max. Negotiated Rate |
$3,329.10 |
| Rate for Payer: Adventist Health Commercial |
$739.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,859.33
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,409.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,289.68
|
| 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 |
$2,172.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,859.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,864.30
|
| Rate for Payer: Cash Price |
$1,664.55
|
| 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: 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: Inland Empire Health Plan (IEHP) medi-cal |
$1,634.17
|
| Rate for Payer: InnovAge PACE Commercial |
$1,849.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,289.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,589.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,589.30
|
| Rate for Payer: Multiplan Commercial |
$2,774.25
|
| 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 LITTLE &OR RING FING
|
Facility
|
OP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
905356010
|
|
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 |
$2,172.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,859.33
|
| Rate for Payer: Blue Shield of California EPN |
$1,864.30
|
| Rate for Payer: Cash Price |
$1,664.55
|
| 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: 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: Inland Empire Health Plan (IEHP) medi-cal |
$1,634.17
|
| Rate for Payer: InnovAge PACE Commercial |
$1,849.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,289.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,589.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,589.30
|
| Rate for Payer: Multiplan Commercial |
$2,774.25
|
| 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 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 |
$2,859.33
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,467.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,409.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,289.68
|
| 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 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 |
$1,844.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,427.22
|
| 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: 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: InnovAge PACE Commercial |
$1,570.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,094.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,943.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,198.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| 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
|
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 |
$1,844.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,427.22
|
| 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: 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: InnovAge PACE Commercial |
$1,570.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,094.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,187.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,943.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,198.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,198.00
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| 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: Adventist Health Commercial |
$628.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,427.22
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,094.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,196.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,943.66
|
| 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
|
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 |
$2,427.22
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,094.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,196.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,943.66
|
| 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 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 |
$2,364.61
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,893.52
|
| 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: 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 |
$1,796.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,364.61
|
| 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: 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: InnovAge PACE Commercial |
$1,529.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,232.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,893.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,141.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| 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 |
$1,796.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,364.61
|
| 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: 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: InnovAge PACE Commercial |
$1,529.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,232.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,893.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,141.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,141.30
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| 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
|
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 |
$2,364.61
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,165.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,893.52
|
| 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 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 |
$909.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.38
|
| 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: 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: InnovAge PACE Commercial |
$774.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$958.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,084.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,084.30
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| 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
|
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 |
$1,197.38
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,033.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$958.83
|
| 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
|
|
