|
HC U1RNP AUTO AB
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.53 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Shield of California Commercial |
$20.28
|
| Rate for Payer: Blue Shield of California Commercial |
$119.19
|
| Rate for Payer: Blue Shield of California Commercial |
$30.67
|
| Rate for Payer: Blue Shield of California Commercial |
$78.83
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Cigna of CA HMO |
$28.16
|
| Rate for Payer: Cigna of CA HMO |
$109.44
|
| Rate for Payer: Cigna of CA PPO |
$126.54
|
| Rate for Payer: Cigna of CA PPO |
$32.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Galaxy Health WC |
$37.40
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Global Benefits Group Commercial |
$26.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
| Rate for Payer: Prime Health Services Commercial |
$37.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC U1RNP AUTO AB
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Adventist Health Commercial |
$34.20
|
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$119.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: EPIC Health Plan Senior |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.04
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
915356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.02
|
| Rate for Payer: Blue Shield of California Commercial |
$438.33
|
| Rate for Payer: Blue Shield of California Commercial |
$288.99
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
915356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
905356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.65 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.02
|
| Rate for Payer: Blue Shield of California Commercial |
$438.33
|
| Rate for Payer: Blue Shield of California Commercial |
$288.99
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$119.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
905356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
905356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
915356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.88 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$138.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.99
|
| Rate for Payer: Blue Shield of California Commercial |
$259.15
|
| Rate for Payer: Blue Shield of California Commercial |
$170.86
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.90
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
905356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.88 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$138.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.99
|
| Rate for Payer: Blue Shield of California Commercial |
$259.15
|
| Rate for Payer: Blue Shield of California Commercial |
$170.86
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.90
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
915356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
905356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$281.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
915356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$95.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$281.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$310.05
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
905356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$405.45 |
| Rate for Payer: Adventist Health Commercial |
$195.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.73
|
| Rate for Payer: Blue Shield of California Commercial |
$366.81
|
| Rate for Payer: Blue Shield of California Commercial |
$241.84
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$281.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
915356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.48 |
| Max. Negotiated Rate |
$405.45 |
| Rate for Payer: Adventist Health Commercial |
$195.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.73
|
| Rate for Payer: Blue Shield of California Commercial |
$366.81
|
| Rate for Payer: Blue Shield of California Commercial |
$241.84
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Senior |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$281.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.90
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.02
|
| Rate for Payer: United Healthcare All Other HMO |
$174.25
|
| Rate for Payer: United Healthcare HMO Rider |
$170.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
905356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.81 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Vantage Medical Group Senior |
$956.25
|
| Rate for Payer: Adventist Health Commercial |
$461.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$618.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$843.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$680.96
|
| Rate for Payer: Blue Shield of California Commercial |
$865.12
|
| Rate for Payer: Blue Shield of California Commercial |
$570.38
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$956.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$956.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$956.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$663.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$956.25
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
905356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$663.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
915356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.81 |
| Max. Negotiated Rate |
$956.25 |
| Rate for Payer: Adventist Health Commercial |
$461.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$618.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$843.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$680.96
|
| Rate for Payer: Blue Shield of California Commercial |
$865.12
|
| Rate for Payer: Blue Shield of California Commercial |
$570.38
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$956.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$956.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$956.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$663.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$787.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$787.50
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$956.25
|
| Rate for Payer: Vantage Medical Group Senior |
$956.25
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
915356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Senior |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$714.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$663.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: Networks By Design Commercial |
$731.25
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.21
|
| Rate for Payer: United Healthcare All Other HMO |
$410.96
|
| Rate for Payer: United Healthcare HMO Rider |
$402.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.44
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
905356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
915356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Adventist Health Commercial |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$370.50
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
915356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.02
|
| Rate for Payer: Blue Shield of California Commercial |
$438.33
|
| Rate for Payer: Blue Shield of California Commercial |
$288.99
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
905356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Adventist Health Commercial |
$233.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$427.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$345.02
|
| Rate for Payer: Blue Shield of California Commercial |
$438.33
|
| Rate for Payer: Blue Shield of California Commercial |
$288.99
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$484.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Senior |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$361.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$147.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$336.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$399.00
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.92
|
| Rate for Payer: United Healthcare All Other HMO |
$208.22
|
| Rate for Payer: United Healthcare HMO Rider |
$203.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
915356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.68 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.03
|
| Rate for Payer: Blue Shield of California Commercial |
$79.60
|
| Rate for Payer: Blue Shield of California Commercial |
$120.73
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
905356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
915356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
