|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
905358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$67.70
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.41
|
|
|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
905358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$48.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$68.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$62.10
|
| Rate for Payer: Blue Shield of California EPN |
$58.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$46.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Senior |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.30
|
| Rate for Payer: Heritage Provider Network Senior |
$46.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$36.46
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$33.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC PROSTHETIC SHEATH BK EACH
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
905358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$60.93
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.07
|
|
|
HC PROSTHETIC SHEATH BK EACH
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
905358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$61.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$55.89
|
| Rate for Payer: Blue Shield of California EPN |
$52.83
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Senior |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$41.67
|
| Rate for Payer: Heritage Provider Network Senior |
$41.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$32.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.07
|
| 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 |
$18.39 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$73.28
|
| Rate for Payer: Blue Shield of California EPN |
$69.27
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.30
|
| Rate for Payer: Dignity Health Senior |
$100.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.52
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.63
|
| Rate for Payer: Heritage Provider Network Senior |
$54.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.42
|
| 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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$23.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$56.64
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$81.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$54.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.72
|
| Rate for Payer: Heritage Provider Network Commercial |
$79.89
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.50
|
| Rate for Payer: Multiplan Commercial |
$88.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$43.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$39.42
|
|
|
HC PROSTHETIC SHRINKER AK EACH
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT L8460
|
| Hospital Charge Code |
905358460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$136.62
|
| Rate for Payer: Blue Shield of California EPN |
$129.14
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.00
|
| Rate for Payer: Dignity Health Senior |
$187.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.86
|
| Rate for Payer: Heritage Provider Network Senior |
$101.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$88.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.50
|
| 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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$105.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$151.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$101.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$148.94
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$80.21
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$73.50
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.23
|
|
|
HC PROSTHETICS LE EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905305999
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$186.30
|
| Rate for Payer: Blue Shield of California EPN |
$176.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$138.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.23
|
| 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 |
$18.39 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$100.60
|
| Rate for Payer: Blue Shield of California EPN |
$95.09
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Senior |
$137.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$75.01
|
| Rate for Payer: Heritage Provider Network Senior |
$75.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.12
|
| 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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$77.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$111.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$74.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$109.67
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.50
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$59.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$54.12
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$203.10
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.23
|
|
|
HC PROSTHETICS UE EVALUATION
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905307499
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$144.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$206.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$186.30
|
| Rate for Payer: Blue Shield of California EPN |
$176.10
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$138.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Senior |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$138.90
|
| Rate for Payer: Heritage Provider Network Senior |
$138.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$109.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$100.23
|
| 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
|
$68.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905103151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
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 |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
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 |
$34.03 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.80
|
| Rate for Payer: Dignity Health Senior |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$116.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905103151
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Senior |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
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 |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
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 |
$34.03 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.80
|
| Rate for Payer: Dignity Health Senior |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$116.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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 |
$34.03 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$159.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$122.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$159.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$159.80
|
| Rate for Payer: Dignity Health Senior |
$159.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$116.37
|
| Rate for Payer: Heritage Provider Network Senior |
$116.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$90.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| 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 |
900400052
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$141.00 |
| Rate for Payer: Adventist Health Commercial |
$37.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$129.16
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$127.28
|
| Rate for Payer: Heritage Provider Network Senior |
$127.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$141.00
|
|
|
HC PROSTHETIC TRAINING 15 MIN OT
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905104520
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$46.04
|
| Rate for Payer: Heritage Provider Network Senior |
$46.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
|
|
HC PROSTHETIC TRAINING 15 MIN OT
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 97761
|
| Hospital Charge Code |
905104520
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.31 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$50.35
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$46.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$44.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.80
|
| Rate for Payer: Dignity Health Senior |
$57.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$42.09
|
| Rate for Payer: Heritage Provider Network Senior |
$42.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$32.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.80
|
| Rate for Payer: Vantage Medical Group Senior |
$57.80
|
|
|
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 |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$43.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$62.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$41.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.14
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.61
|
| Rate for Payer: Heritage Provider Network Senior |
$7,571.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.75
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$33.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$30.40
|
|
