|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
915356691
|
|
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
|
|
|
HC UE ADD ROTAT WRIST W/CABLE LCK
|
Facility
|
IP
|
$2,862.00
|
|
|
Service Code
|
CPT L6625
|
| Hospital Charge Code |
905356625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$572.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cigna of CA HMO |
$2,003.40
|
| Rate for Payer: Cigna of CA PPO |
$2,003.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,144.80
|
| Rate for Payer: Galaxy Health WC |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,090.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,771.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.88
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: Networks By Design Commercial |
$1,431.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,074.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,045.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,022.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$937.30
|
|
|
HC UE ADD ROTAT WRIST W/CABLE LCK
|
Facility
|
OP
|
$2,862.00
|
|
|
Service Code
|
CPT L6625
|
| Hospital Charge Code |
905356625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$458.07 |
| Max. Negotiated Rate |
$2,432.70 |
| Rate for Payer: Adventist Health Commercial |
$1,173.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,432.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,574.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,146.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,657.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,112.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,390.93
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cigna of CA HMO |
$2,003.40
|
| Rate for Payer: Cigna of CA PPO |
$2,003.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,432.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,432.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,432.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,144.80
|
| Rate for Payer: Galaxy Health WC |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$458.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,771.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,003.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: Networks By Design Commercial |
$1,431.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,717.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,717.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,074.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,045.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,022.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$937.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,432.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,432.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,432.70
|
|
|
HC UE ADD ROTAT WRIST W/CABLE LCK
|
Facility
|
OP
|
$2,862.00
|
|
|
Service Code
|
CPT L6625
|
| Hospital Charge Code |
915356625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$458.07 |
| Max. Negotiated Rate |
$2,432.70 |
| Rate for Payer: Adventist Health Commercial |
$1,173.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,432.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,574.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,146.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,657.67
|
| Rate for Payer: Blue Shield of California Commercial |
$2,112.16
|
| Rate for Payer: Blue Shield of California EPN |
$1,390.93
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cigna of CA HMO |
$2,003.40
|
| Rate for Payer: Cigna of CA PPO |
$2,003.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,432.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,432.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,432.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,144.80
|
| Rate for Payer: Galaxy Health WC |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$458.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$518.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,771.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,003.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,003.40
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: Networks By Design Commercial |
$1,431.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,717.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,717.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,074.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,045.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,022.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$937.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,432.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,432.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,432.70
|
|
|
HC UE ADD ROTAT WRIST W/CABLE LCK
|
Facility
|
IP
|
$2,862.00
|
|
|
Service Code
|
CPT L6625
|
| Hospital Charge Code |
915356625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$572.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cash Price |
$1,574.10
|
| Rate for Payer: Cigna of CA HMO |
$2,003.40
|
| Rate for Payer: Cigna of CA PPO |
$2,003.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,144.80
|
| Rate for Payer: Galaxy Health WC |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,090.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,771.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$686.88
|
| Rate for Payer: Multiplan Commercial |
$2,289.60
|
| Rate for Payer: Networks By Design Commercial |
$1,431.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,074.11
|
| Rate for Payer: United Healthcare All Other HMO |
$1,045.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,022.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$937.30
|
|
|
HC UE ADD SHLDR JNT MULTIPOS LOCK
|
Facility
|
OP
|
$4,966.00
|
|
|
Service Code
|
CPT L6646
|
| Hospital Charge Code |
915356646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,191.84 |
| Max. Negotiated Rate |
$4,221.10 |
| Rate for Payer: Adventist Health Commercial |
$2,036.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,221.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,731.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,724.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,876.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,664.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,413.48
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cigna of CA HMO |
$3,476.20
|
| Rate for Payer: Cigna of CA PPO |
$3,476.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,221.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,221.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,221.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.40
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,337.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,312.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,774.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,476.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,476.20
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Networks By Design Commercial |
$2,483.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,863.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,814.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,774.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,626.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,221.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,221.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,221.10
|
|
|
HC UE ADD SHLDR JNT MULTIPOS LOCK
|
Facility
|
IP
|
$4,966.00
|
|
|
Service Code
|
CPT L6646
|
| Hospital Charge Code |
915356646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$993.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$993.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cigna of CA HMO |
$3,476.20
|
| Rate for Payer: Cigna of CA PPO |
$3,476.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.40
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,312.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,892.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.84
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Networks By Design Commercial |
$2,483.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,863.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,814.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,774.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,626.37
|
|
|
HC UE ADD SHLDR JNT MULTIPOS LOCK
|
Facility
|
OP
|
$4,966.00
|
|
|
Service Code
|
CPT L6646
|
| Hospital Charge Code |
905356646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,191.84 |
| Max. Negotiated Rate |
$4,221.10 |
| Rate for Payer: Adventist Health Commercial |
$2,036.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,221.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,731.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,724.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,876.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,664.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,413.48
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cigna of CA HMO |
$3,476.20
|
| Rate for Payer: Cigna of CA PPO |
$3,476.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,221.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,221.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,221.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.40
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,337.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,312.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,774.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,476.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,476.20
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Networks By Design Commercial |
$2,483.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,863.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,814.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,774.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,626.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,221.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,221.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,221.10
|
|
|
HC UE ADD SHLDR JNT MULTIPOS LOCK
|
Facility
|
IP
|
$4,966.00
|
|
|
Service Code
|
CPT L6646
|
| Hospital Charge Code |
905356646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$993.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$993.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cash Price |
$2,731.30
|
| Rate for Payer: Cigna of CA HMO |
$3,476.20
|
| Rate for Payer: Cigna of CA PPO |
$3,476.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,986.40
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,312.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,892.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,073.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.84
|
| Rate for Payer: Multiplan Commercial |
$3,972.80
|
| Rate for Payer: Networks By Design Commercial |
$2,483.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,863.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,814.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,774.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,626.37
|
|
|
HC UE ADD SHLDR LOCK BODY-POWERED
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT L6647
|
| Hospital Charge Code |
905356647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.32 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$335.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$613.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.79
|
| Rate for Payer: Blue Shield of California Commercial |
$603.68
|
| Rate for Payer: Blue Shield of California EPN |
$397.55
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cigna of CA HMO |
$572.60
|
| Rate for Payer: Cigna of CA PPO |
$572.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$695.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$695.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$549.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$572.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$572.60
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$409.00
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.00
|
| Rate for Payer: United Healthcare All Other HMO |
$298.82
|
| Rate for Payer: United Healthcare HMO Rider |
$292.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$695.30
|
| Rate for Payer: Vantage Medical Group Senior |
$695.30
|
|
|
HC UE ADD SHLDR LOCK BODY-POWERED
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT L6647
|
| Hospital Charge Code |
915356647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cigna of CA HMO |
$572.60
|
| Rate for Payer: Cigna of CA PPO |
$572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$409.00
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.00
|
| Rate for Payer: United Healthcare All Other HMO |
$298.82
|
| Rate for Payer: United Healthcare HMO Rider |
$292.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.89
|
|
|
HC UE ADD SHLDR LOCK BODY-POWERED
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
CPT L6647
|
| Hospital Charge Code |
915356647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.32 |
| Max. Negotiated Rate |
$695.30 |
| Rate for Payer: Adventist Health Commercial |
$335.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$613.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.79
|
| Rate for Payer: Blue Shield of California Commercial |
$603.68
|
| Rate for Payer: Blue Shield of California EPN |
$397.55
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cigna of CA HMO |
$572.60
|
| Rate for Payer: Cigna of CA PPO |
$572.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$695.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$695.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$549.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$572.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$572.60
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$409.00
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.00
|
| Rate for Payer: United Healthcare All Other HMO |
$298.82
|
| Rate for Payer: United Healthcare HMO Rider |
$292.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$695.30
|
| Rate for Payer: Vantage Medical Group Senior |
$695.30
|
|
|
HC UE ADD SHLDR LOCK BODY-POWERED
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
CPT L6647
|
| Hospital Charge Code |
905356647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$163.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cash Price |
$449.90
|
| Rate for Payer: Cigna of CA HMO |
$572.60
|
| Rate for Payer: Cigna of CA PPO |
$572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Senior |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.32
|
| Rate for Payer: Multiplan Commercial |
$654.40
|
| Rate for Payer: Networks By Design Commercial |
$409.00
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.00
|
| Rate for Payer: United Healthcare All Other HMO |
$298.82
|
| Rate for Payer: United Healthcare HMO Rider |
$292.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.89
|
|
|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
|
IP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
915356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,024.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,048.80
|
| Rate for Payer: Galaxy Health WC |
$4,353.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,073.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,416.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,951.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,170.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.28
|
| Rate for Payer: Multiplan Commercial |
$4,097.60
|
| Rate for Payer: Networks By Design Commercial |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,677.45
|
|
|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
|
OP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
915356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,229.28 |
| Max. Negotiated Rate |
$4,353.70 |
| Rate for Payer: Adventist Health Commercial |
$2,100.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,817.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,966.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,780.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,489.29
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,353.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,353.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,048.80
|
| Rate for Payer: Galaxy Health WC |
$4,353.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,073.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,441.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,416.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,892.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,170.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,585.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,585.40
|
| Rate for Payer: Multiplan Commercial |
$4,097.60
|
| Rate for Payer: Networks By Design Commercial |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,073.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,073.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,677.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,353.70
|
|
|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
|
OP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
905356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,229.28 |
| Max. Negotiated Rate |
$4,353.70 |
| Rate for Payer: Adventist Health Commercial |
$2,100.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,817.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,966.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,780.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,489.29
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,353.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,353.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,048.80
|
| Rate for Payer: Galaxy Health WC |
$4,353.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,073.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,441.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,416.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,892.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,170.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,585.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,585.40
|
| Rate for Payer: Multiplan Commercial |
$4,097.60
|
| Rate for Payer: Networks By Design Commercial |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,073.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,073.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,677.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,353.70
|
|
|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
|
IP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
905356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,024.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,024.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cash Price |
$2,817.10
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,048.80
|
| Rate for Payer: Galaxy Health WC |
$4,353.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,073.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,416.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,951.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,170.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,229.28
|
| Rate for Payer: Multiplan Commercial |
$4,097.60
|
| Rate for Payer: Networks By Design Commercial |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,677.45
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
915356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
905356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
905356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.72 |
| Max. Negotiated Rate |
$555.05 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.22
|
| Rate for Payer: Blue Shield of California Commercial |
$481.91
|
| Rate for Payer: Blue Shield of California EPN |
$317.36
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
915356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.72 |
| Max. Negotiated Rate |
$555.05 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$378.22
|
| Rate for Payer: Blue Shield of California Commercial |
$481.91
|
| Rate for Payer: Blue Shield of California EPN |
$317.36
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$184.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
905356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$779.45 |
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.13
|
| Rate for Payer: Blue Shield of California Commercial |
$676.75
|
| Rate for Payer: Blue Shield of California EPN |
$445.66
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$641.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
915356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
915356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.08 |
| Max. Negotiated Rate |
$779.45 |
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$531.13
|
| Rate for Payer: Blue Shield of California Commercial |
$676.75
|
| Rate for Payer: Blue Shield of California EPN |
$445.66
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$641.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
905356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.08
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
