|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$914.10
|
| Rate for Payer: Cash Price |
$914.10
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.88 |
| Max. Negotiated Rate |
$1,412.70 |
| Rate for Payer: Adventist Health Commercial |
$681.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,246.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$962.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,226.56
|
| Rate for Payer: Blue Shield of California EPN |
$807.73
|
| Rate for Payer: Cash Price |
$914.10
|
| Rate for Payer: Cash Price |
$914.10
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,412.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$612.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$693.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,163.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,163.40
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,412.70
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.77
|
| Rate for Payer: Blue Shield of California Commercial |
$86.35
|
| Rate for Payer: Blue Shield of California EPN |
$56.86
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.77
|
| Rate for Payer: Blue Shield of California Commercial |
$86.35
|
| Rate for Payer: Blue Shield of California EPN |
$56.86
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.72 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.18
|
| Rate for Payer: Blue Shield of California Commercial |
$518.81
|
| Rate for Payer: Blue Shield of California EPN |
$341.66
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.72 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.18
|
| Rate for Payer: Blue Shield of California Commercial |
$518.81
|
| Rate for Payer: Blue Shield of California EPN |
$341.66
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$945.12 |
| Max. Negotiated Rate |
$3,347.30 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,280.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2,906.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,913.87
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,646.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$945.12 |
| Max. Negotiated Rate |
$3,347.30 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,280.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2,906.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,913.87
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,646.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
915356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$203.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.84
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
905356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.84 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: Adventist Health Commercial |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$762.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.47
|
| Rate for Payer: Blue Shield of California Commercial |
$749.81
|
| Rate for Payer: Blue Shield of California EPN |
$493.78
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$863.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$863.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$711.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$711.20
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.60
|
| Rate for Payer: Vantage Medical Group Senior |
$863.60
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
905356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$203.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.84
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
915356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.84 |
| Max. Negotiated Rate |
$863.60 |
| Rate for Payer: Adventist Health Commercial |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$762.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.47
|
| Rate for Payer: Blue Shield of California Commercial |
$749.81
|
| Rate for Payer: Blue Shield of California EPN |
$493.78
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$863.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$863.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$471.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$711.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$711.20
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.60
|
| Rate for Payer: Vantage Medical Group Senior |
$863.60
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
915356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.76
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
915356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.76 |
| Max. Negotiated Rate |
$402.90 |
| Rate for Payer: Adventist Health Commercial |
$194.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$355.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.54
|
| Rate for Payer: Blue Shield of California Commercial |
$349.81
|
| Rate for Payer: Blue Shield of California EPN |
$230.36
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.80
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
905356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.76
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
905356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.76 |
| Max. Negotiated Rate |
$402.90 |
| Rate for Payer: Adventist Health Commercial |
$194.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$355.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.54
|
| Rate for Payer: Blue Shield of California Commercial |
$349.81
|
| Rate for Payer: Blue Shield of California EPN |
$230.36
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$133.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.80
|
| Rate for Payer: Multiplan Commercial |
$379.20
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
915356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$95.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
905356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$95.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
905356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.72 |
| Max. Negotiated Rate |
$406.30 |
| Rate for Payer: Adventist Health Commercial |
$195.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.86
|
| Rate for Payer: Blue Shield of California Commercial |
$352.76
|
| Rate for Payer: Blue Shield of California EPN |
$232.31
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$351.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.60
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.30
|
| Rate for Payer: Vantage Medical Group Senior |
$406.30
|
|
