|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.20 |
| Max. Negotiated Rate |
$1,449.25 |
| Rate for Payer: Adventist Health Commercial |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$937.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,032.04
|
| Rate for Payer: Blue Shield of California Commercial |
$864.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,311.14
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,449.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,449.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$693.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$784.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,193.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$1,364.00
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,449.25
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.20
|
| Rate for Payer: Multiplan Commercial |
$1,364.00
|
| Rate for Payer: Networks By Design Commercial |
$1,108.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
915356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.20 |
| Max. Negotiated Rate |
$1,449.25 |
| Rate for Payer: Adventist Health Commercial |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$937.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,032.04
|
| Rate for Payer: Blue Shield of California Commercial |
$864.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,311.14
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,449.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,449.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$693.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$784.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,193.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$1,364.00
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,449.25
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
915356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.20
|
| Rate for Payer: Multiplan Commercial |
$1,364.00
|
| Rate for Payer: Networks By Design Commercial |
$1,108.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
915356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
915356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.38
|
| Rate for Payer: Blue Shield of California Commercial |
$199.94
|
| Rate for Payer: Blue Shield of California Commercial |
$131.82
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$221.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.38
|
| Rate for Payer: Blue Shield of California Commercial |
$199.94
|
| Rate for Payer: Blue Shield of California Commercial |
$131.82
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$221.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
905356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.88 |
| Max. Negotiated Rate |
$1,412.70 |
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Adventist Health Commercial |
$681.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,246.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,006.01
|
| Rate for Payer: Blue Shield of California Commercial |
$842.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,278.08
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,412.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,412.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$612.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$693.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,163.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,163.40
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,412.70
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$398.88 |
| Max. Negotiated Rate |
$1,412.70 |
| Rate for Payer: Adventist Health Commercial |
$681.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,246.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,006.01
|
| Rate for Payer: Blue Shield of California Commercial |
$842.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,278.08
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,412.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,412.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$612.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$693.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,163.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,163.40
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,412.70
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
905356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.88
|
| Rate for Payer: Multiplan Commercial |
$1,329.60
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$89.97
|
| Rate for Payer: Blue Shield of California Commercial |
$59.32
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.08 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$89.97
|
| Rate for Payer: Blue Shield of California Commercial |
$59.32
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.72 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.53
|
| Rate for Payer: Blue Shield of California Commercial |
$540.61
|
| Rate for Payer: Blue Shield of California Commercial |
$356.42
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$168.72 |
| Max. Negotiated Rate |
$597.55 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.53
|
| Rate for Payer: Blue Shield of California Commercial |
$540.61
|
| Rate for Payer: Blue Shield of California Commercial |
$356.42
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$562.40
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$945.12 |
| Max. Negotiated Rate |
$3,347.30 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,383.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,028.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,996.57
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,646.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$2,559.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$945.12 |
| Max. Negotiated Rate |
$3,347.30 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,383.67
|
| Rate for Payer: Blue Shield of California Commercial |
$3,028.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,996.57
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,646.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$945.12
|
| Rate for Payer: Multiplan Commercial |
$3,150.40
|
| Rate for Payer: Networks By Design Commercial |
$2,559.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
905356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$203.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$645.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$599.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.84
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: Networks By Design Commercial |
$660.40
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
|
