|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
915356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$405.45 |
| Rate for Payer: Adventist Health Commercial |
$195.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.28
|
| Rate for Payer: Blue Shield of California Commercial |
$352.03
|
| Rate for Payer: Blue Shield of California EPN |
$231.82
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
915356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
905356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
905356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$405.45 |
| Rate for Payer: Adventist Health Commercial |
$195.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.28
|
| Rate for Payer: Blue Shield of California Commercial |
$352.03
|
| Rate for Payer: Blue Shield of California EPN |
$231.82
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
915356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.81 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Adventist Health Commercial |
$461.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$618.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$843.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.60
|
| Rate for Payer: Blue Shield of California Commercial |
$830.25
|
| Rate for Payer: Blue Shield of California EPN |
$546.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$956.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$956.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$956.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$956.25
|
| Rate for Payer: Vantage Medical Group Senior |
$956.25
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
905356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.81 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Adventist Health Commercial |
$461.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$618.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$843.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.60
|
| Rate for Payer: Blue Shield of California Commercial |
$830.25
|
| Rate for Payer: Blue Shield of California EPN |
$546.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$956.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$956.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$956.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$956.25
|
| Rate for Payer: Vantage Medical Group Senior |
$956.25
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
915356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
905356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cash Price |
$618.75
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
915356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
905356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.14
|
| Rate for Payer: Blue Shield of California Commercial |
$420.66
|
| Rate for Payer: Blue Shield of California EPN |
$277.02
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
905356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
915356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.14
|
| Rate for Payer: Blue Shield of California Commercial |
$420.66
|
| Rate for Payer: Blue Shield of California EPN |
$277.02
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cash Price |
$313.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$352.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
905356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
915356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
905356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.93
|
| Rate for Payer: Blue Shield of California Commercial |
$115.87
|
| Rate for Payer: Blue Shield of California EPN |
$76.30
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
915356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.93
|
| Rate for Payer: Blue Shield of California Commercial |
$115.87
|
| Rate for Payer: Blue Shield of California EPN |
$76.30
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
915356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
905356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$592.45 |
| Rate for Payer: Adventist Health Commercial |
$285.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.70
|
| Rate for Payer: Blue Shield of California Commercial |
$514.39
|
| Rate for Payer: Blue Shield of California EPN |
$338.74
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.90
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
905356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
915356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.28 |
| Max. Negotiated Rate |
$592.45 |
| Rate for Payer: Adventist Health Commercial |
$285.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.70
|
| Rate for Payer: Blue Shield of California Commercial |
$514.39
|
| Rate for Payer: Blue Shield of California EPN |
$338.74
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cash Price |
$383.35
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$431.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.90
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
905356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Adventist Health Commercial |
$185.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.80
|
| Rate for Payer: Blue Shield of California Commercial |
$333.58
|
| Rate for Payer: Blue Shield of California EPN |
$219.67
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$316.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
905356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
915356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.48 |
| Max. Negotiated Rate |
$384.20 |
| Rate for Payer: Adventist Health Commercial |
$185.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.80
|
| Rate for Payer: Blue Shield of California Commercial |
$333.58
|
| Rate for Payer: Blue Shield of California EPN |
$219.67
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$316.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
915356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cash Price |
$248.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$279.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.48
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
|
|
HC UE ADD HOOK TO HAND CABLE ADAP
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
905356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
