|
HC PROSTHETIC SHEATH BK EACH
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
905358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.50 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$69.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.17
|
| Rate for Payer: BCBS Transplant Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.50
|
| Rate for Payer: Blue Shield of California EPN |
$48.96
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$67.50
|
| Rate for Payer: IEHP medi-cal |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.90
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC PROSTHETIC SHEATH WOOL BK EACH
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT L8420
|
| Hospital Charge Code |
905358420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$57.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.71
|
| Rate for Payer: BCBS Transplant Transplant |
$70.80
|
| Rate for Payer: Blue Shield of California Commercial |
$88.50
|
| Rate for Payer: Blue Shield of California EPN |
$64.19
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$82.60
|
| Rate for Payer: Cigna of CA PPO |
$82.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$88.50
|
| Rate for Payer: IEHP medi-cal |
$41.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.38
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$59.00
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
| Rate for Payer: Riverside University Health MISP |
$47.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.00
|
| Rate for Payer: United Healthcare All Other HMO |
$59.00
|
| Rate for Payer: United Healthcare HMO Rider |
$59.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.30
|
| Rate for Payer: Vantage Medical Group Senior |
$100.30
|
|
|
HC PROSTHETIC SHEATH WOOL BK EACH
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT L8420
|
| Hospital Charge Code |
905358420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Blue Shield of California EPN |
$63.01
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Central Health Plan Commercial |
$94.40
|
| Rate for Payer: Cigna of CA HMO |
$82.60
|
| Rate for Payer: Cigna of CA PPO |
$82.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.20
|
| Rate for Payer: Galaxy Health WC |
$100.30
|
| Rate for Payer: Global Benefits Group Commercial |
$70.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$106.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.60
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: Networks By Design Commercial |
$59.00
|
| Rate for Payer: Prime Health Services Commercial |
$100.30
|
|
|
HC PROSTHETIC SHRINKER AK EACH
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT L8460
|
| Hospital Charge Code |
905358460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$294.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$294.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$121.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$121.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.98
|
| Rate for Payer: BCBS Transplant Transplant |
$132.00
|
| Rate for Payer: Blue Shield of California Commercial |
$165.00
|
| Rate for Payer: Blue Shield of California EPN |
$119.68
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$154.00
|
| Rate for Payer: Cigna of CA PPO |
$154.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$165.00
|
| Rate for Payer: IEHP medi-cal |
$77.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.20
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$110.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Riverside University Health MISP |
$88.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.00
|
| Rate for Payer: United Healthcare All Other HMO |
$110.00
|
| Rate for Payer: United Healthcare HMO Rider |
$110.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.00
|
| Rate for Payer: Vantage Medical Group Senior |
$187.00
|
|
|
HC PROSTHETIC SHRINKER AK EACH
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT L8460
|
| Hospital Charge Code |
905358460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Blue Shield of California EPN |
$117.48
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$154.00
|
| Rate for Payer: Cigna of CA PPO |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$110.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC PROSTHETICS LE EVALUATION
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905305999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Blue Shield of California EPN |
$160.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC PROSTHETICS LE EVALUATION
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905305999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.24
|
| Rate for Payer: BCBS Transplant Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.00
|
| Rate for Payer: Blue Shield of California EPN |
$163.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$225.00
|
| Rate for Payer: IEHP medi-cal |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PROSTHETIC SOCK WOOL AK EACH
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
CPT L8430
|
| Hospital Charge Code |
905358430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$97.93
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$89.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.71
|
| Rate for Payer: BCBS Transplant Transplant |
$97.20
|
| Rate for Payer: Blue Shield of California Commercial |
$121.50
|
| Rate for Payer: Blue Shield of California EPN |
$88.13
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$121.50
|
| Rate for Payer: IEHP medi-cal |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.42
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Riverside University Health MISP |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81.00
|
| Rate for Payer: United Healthcare HMO Rider |
$81.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC PROSTHETIC SOCK WOOL AK EACH
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT L8430
|
| Hospital Charge Code |
905358430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Blue Shield of California EPN |
$86.51
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC PROSTHETICS UE EVALUATION
|
Facility
IP
|
$300.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905307499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Blue Shield of California EPN |
$160.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC PROSTHETICS UE EVALUATION
|
Facility
OP
|
$300.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905307499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.24
|
| Rate for Payer: BCBS Transplant Transplant |
$180.00
|
| Rate for Payer: Blue Shield of California Commercial |
$225.00
|
| Rate for Payer: Blue Shield of California EPN |
$163.20
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$210.00
|
| Rate for Payer: Cigna of CA PPO |
$210.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$225.00
|
| Rate for Payer: IEHP medi-cal |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$150.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC PROSTHETIC TRAIN 15 MIN PT
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
900417520
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
|
|
HC PROSTHETIC TRAIN 15 MIN PT
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905103151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$112.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: Cigna of CA HMO |
$120.32
|
| Rate for Payer: Cigna of CA PPO |
$139.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$141.00
|
| Rate for Payer: IEHP medi-cal |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.08
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: Riverside University Health MISP |
$75.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.80
|
| Rate for Payer: Vantage Medical Group Senior |
$159.80
|
|
|
HC PROSTHETIC TRAIN 15 MIN PT
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905103151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
|
|
HC PROSTHETIC TRAIN 15 MIN PT
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
900417520
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$112.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: Cigna of CA HMO |
$120.32
|
| Rate for Payer: Cigna of CA PPO |
$139.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$141.00
|
| Rate for Payer: IEHP medi-cal |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.08
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: Riverside University Health MISP |
$75.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.80
|
| Rate for Payer: Vantage Medical Group Senior |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
900400052
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$112.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: Cigna of CA HMO |
$120.32
|
| Rate for Payer: Cigna of CA PPO |
$139.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$141.00
|
| Rate for Payer: IEHP medi-cal |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.08
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: Riverside University Health MISP |
$75.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.80
|
| Rate for Payer: Vantage Medical Group Senior |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
901300079
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$112.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: Cigna of CA HMO |
$120.32
|
| Rate for Payer: Cigna of CA PPO |
$139.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$141.00
|
| Rate for Payer: IEHP medi-cal |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.08
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: Riverside University Health MISP |
$75.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.80
|
| Rate for Payer: Vantage Medical Group Senior |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
901300079
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN MCAL
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
900400052
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN OT
|
Facility
IP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905104520
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.60
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
|
|
HC PROSTHETIC TRAINING 15 MIN OT
|
Facility
OP
|
$188.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905104520
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$127.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$103.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$112.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Central Health Plan Commercial |
$150.40
|
| Rate for Payer: Cigna of CA HMO |
$120.32
|
| Rate for Payer: Cigna of CA PPO |
$139.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$75.20
|
| Rate for Payer: Galaxy Health WC |
$159.80
|
| Rate for Payer: Global Benefits Group Commercial |
$112.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$169.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$141.00
|
| Rate for Payer: IEHP medi-cal |
$65.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$125.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.08
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: Networks By Design Commercial |
$122.20
|
| Rate for Payer: Prime Health Services Commercial |
$159.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: Riverside University Health MISP |
$75.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$159.80
|
| Rate for Payer: Vantage Medical Group Senior |
$159.80
|
|
|
HC PROSTH SHEATH UPPER LIMB EACH
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT L8415
|
| Hospital Charge Code |
905358415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$94.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$94.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$66.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.08
|
| Rate for Payer: BCBS Transplant Transplant |
$46.80
|
| Rate for Payer: Blue Shield of California Commercial |
$58.50
|
| Rate for Payer: Blue Shield of California EPN |
$42.43
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.50
|
| Rate for Payer: IEHP medi-cal |
$27.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.98
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Riverside University Health MISP |
$31.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.30
|
| Rate for Payer: Vantage Medical Group Senior |
$66.30
|
|
|
HC PROSTH SHEATH UPPER LIMB EACH
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT L8415
|
| Hospital Charge Code |
905358415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Blue Shield of California EPN |
$41.65
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$54.60
|
| Rate for Payer: Cigna of CA PPO |
$54.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.20
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
|
|
HC PROSTH SHRINKER UPPER LIMB EA
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT L8465
|
| Hospital Charge Code |
905358465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.85 |
| Max. Negotiated Rate |
$215.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$215.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.76
|
| Rate for Payer: BCBS Transplant Transplant |
$54.60
|
| Rate for Payer: Blue Shield of California Commercial |
$68.25
|
| Rate for Payer: Blue Shield of California EPN |
$49.50
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$68.25
|
| Rate for Payer: IEHP medi-cal |
$31.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.31
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Riverside University Health MISP |
$36.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.50
|
| Rate for Payer: United Healthcare All Other HMO |
$45.50
|
| Rate for Payer: United Healthcare HMO Rider |
$45.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.35
|
| Rate for Payer: Vantage Medical Group Senior |
$77.35
|
|
|
HC PROSTH SHRINKER UPPER LIMB EA
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT L8465
|
| Hospital Charge Code |
905358465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Blue Shield of California EPN |
$48.59
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
|
