|
HC ELEC KNEE-SHIN SWING/STANCE
|
Facility
|
OP
|
$47,249.00
|
|
|
Service Code
|
CPT L5856
|
| Hospital Charge Code |
915355856
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,339.76 |
| Max. Negotiated Rate |
$40,161.65 |
| Rate for Payer: Adventist Health Commercial |
$19,372.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,986.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,436.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,366.62
|
| Rate for Payer: Blue Shield of California Commercial |
$34,869.76
|
| Rate for Payer: Blue Shield of California EPN |
$22,963.01
|
| Rate for Payer: Cash Price |
$21,262.05
|
| Rate for Payer: Cash Price |
$21,262.05
|
| Rate for Payer: Cigna of CA HMO |
$33,074.30
|
| Rate for Payer: Cigna of CA PPO |
$33,074.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,161.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,161.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,899.60
|
| Rate for Payer: Galaxy Health WC |
$40,161.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,349.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25,401.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,515.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,727.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,247.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,339.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,074.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,074.30
|
| Rate for Payer: Multiplan Commercial |
$37,799.20
|
| Rate for Payer: Networks By Design Commercial |
$23,624.50
|
| Rate for Payer: Prime Health Services Commercial |
$40,161.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,349.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,349.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,732.55
|
| Rate for Payer: United Healthcare All Other HMO |
$17,260.06
|
| Rate for Payer: United Healthcare HMO Rider |
$16,886.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,474.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,161.65
|
| Rate for Payer: Vantage Medical Group Senior |
$40,161.65
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
OP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
905357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,600.88 |
| Max. Negotiated Rate |
$19,836.45 |
| Rate for Payer: Adventist Health Commercial |
$9,568.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,835.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,502.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,516.79
|
| Rate for Payer: Blue Shield of California Commercial |
$17,222.71
|
| Rate for Payer: Blue Shield of California EPN |
$11,341.78
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,836.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,836.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,953.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,733.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,335.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,335.90
|
| Rate for Payer: Multiplan Commercial |
$18,669.60
|
| Rate for Payer: Networks By Design Commercial |
$11,668.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,002.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,002.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Senior |
$19,836.45
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
OP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
915357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,600.88 |
| Max. Negotiated Rate |
$19,836.45 |
| Rate for Payer: Adventist Health Commercial |
$9,568.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,835.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,502.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,516.79
|
| Rate for Payer: Blue Shield of California Commercial |
$17,222.71
|
| Rate for Payer: Blue Shield of California EPN |
$11,341.78
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,836.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,836.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,953.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,733.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,335.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,335.90
|
| Rate for Payer: Multiplan Commercial |
$18,669.60
|
| Rate for Payer: Networks By Design Commercial |
$11,668.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,002.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,002.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Senior |
$19,836.45
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
IP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
915357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,667.40 |
| Max. Negotiated Rate |
$19,836.45 |
| Rate for Payer: Adventist Health Commercial |
$4,667.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,891.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.88
|
| Rate for Payer: Multiplan Commercial |
$18,669.60
|
| Rate for Payer: Networks By Design Commercial |
$11,668.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
IP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
905357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,667.40 |
| Max. Negotiated Rate |
$19,836.45 |
| Rate for Payer: Adventist Health Commercial |
$4,667.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,891.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,600.88
|
| Rate for Payer: Multiplan Commercial |
$18,669.60
|
| Rate for Payer: Networks By Design Commercial |
$11,668.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
IP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
915357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,482.60 |
| Max. Negotiated Rate |
$14,801.05 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,634.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,179.12
|
| Rate for Payer: Multiplan Commercial |
$13,930.40
|
| Rate for Payer: Networks By Design Commercial |
$8,706.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
IP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
905357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,482.60 |
| Max. Negotiated Rate |
$14,801.05 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,634.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,179.12
|
| Rate for Payer: Multiplan Commercial |
$13,930.40
|
| Rate for Payer: Networks By Design Commercial |
$8,706.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
OP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
905357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,179.12 |
| Max. Negotiated Rate |
$14,801.05 |
| Rate for Payer: Adventist Health Commercial |
$7,139.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,577.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,059.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,085.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12,850.79
|
| Rate for Payer: Blue Shield of California EPN |
$8,462.72
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,801.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,801.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,527.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,120.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,179.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,189.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,189.10
|
| Rate for Payer: Multiplan Commercial |
$13,930.40
|
| Rate for Payer: Networks By Design Commercial |
$8,706.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,447.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,447.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14,801.05
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
OP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
915357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,179.12 |
| Max. Negotiated Rate |
$14,801.05 |
| Rate for Payer: Adventist Health Commercial |
$7,139.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,577.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,059.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,085.61
|
| Rate for Payer: Blue Shield of California Commercial |
$12,850.79
|
| Rate for Payer: Blue Shield of California EPN |
$8,462.72
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,801.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,801.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,527.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,120.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,179.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,189.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,189.10
|
| Rate for Payer: Multiplan Commercial |
$13,930.40
|
| Rate for Payer: Networks By Design Commercial |
$8,706.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,447.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,447.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14,801.05
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
IP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
905357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,562.40 |
| Max. Negotiated Rate |
$23,640.20 |
| Rate for Payer: Adventist Health Commercial |
$5,562.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,596.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.88
|
| Rate for Payer: Multiplan Commercial |
$22,249.60
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
OP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
915357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,674.88 |
| Max. Negotiated Rate |
$23,640.20 |
| Rate for Payer: Adventist Health Commercial |
$11,402.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,296.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,859.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,108.71
|
| Rate for Payer: Blue Shield of California Commercial |
$20,525.26
|
| Rate for Payer: Blue Shield of California EPN |
$13,516.63
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,640.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,640.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,906.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,941.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,468.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,468.40
|
| Rate for Payer: Multiplan Commercial |
$22,249.60
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,687.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,687.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Senior |
$23,640.20
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
IP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
915357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,562.40 |
| Max. Negotiated Rate |
$23,640.20 |
| Rate for Payer: Adventist Health Commercial |
$5,562.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,596.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.88
|
| Rate for Payer: Multiplan Commercial |
$22,249.60
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
OP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
905357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,674.88 |
| Max. Negotiated Rate |
$23,640.20 |
| Rate for Payer: Adventist Health Commercial |
$11,402.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,296.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,859.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,108.71
|
| Rate for Payer: Blue Shield of California Commercial |
$20,525.26
|
| Rate for Payer: Blue Shield of California EPN |
$13,516.63
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,640.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,640.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,906.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,941.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,674.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,468.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,468.40
|
| Rate for Payer: Multiplan Commercial |
$22,249.60
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,687.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,687.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Senior |
$23,640.20
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
IP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
915357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,308.00 |
| Max. Negotiated Rate |
$22,559.00 |
| Rate for Payer: Adventist Health Commercial |
$5,308.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,111.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,369.60
|
| Rate for Payer: Multiplan Commercial |
$21,232.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
IP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
905357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,308.00 |
| Max. Negotiated Rate |
$22,559.00 |
| Rate for Payer: Adventist Health Commercial |
$5,308.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,111.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,369.60
|
| Rate for Payer: Multiplan Commercial |
$21,232.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
OP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
905357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,369.60 |
| Max. Negotiated Rate |
$22,559.00 |
| Rate for Payer: Adventist Health Commercial |
$10,881.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,597.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,905.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,371.97
|
| Rate for Payer: Blue Shield of California Commercial |
$19,586.52
|
| Rate for Payer: Blue Shield of California EPN |
$12,898.44
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,559.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,559.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,379.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,215.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,369.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,578.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,578.00
|
| Rate for Payer: Multiplan Commercial |
$21,232.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,559.00
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
OP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
915357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,369.60 |
| Max. Negotiated Rate |
$22,559.00 |
| Rate for Payer: Adventist Health Commercial |
$10,881.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,597.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,905.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,371.97
|
| Rate for Payer: Blue Shield of California Commercial |
$19,586.52
|
| Rate for Payer: Blue Shield of California EPN |
$12,898.44
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,559.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,559.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,379.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,215.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,369.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,578.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,578.00
|
| Rate for Payer: Multiplan Commercial |
$21,232.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,559.00
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
IP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,403.80 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$3,403.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
OP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
915357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,084.56 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$6,977.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,360.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,857.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,560.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,271.23
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,466.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,466.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,887.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,913.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,913.30
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,466.15
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
IP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
915357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,403.80 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$3,403.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
OP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,084.56 |
| Max. Negotiated Rate |
$14,466.15 |
| Rate for Payer: Adventist Health Commercial |
$6,977.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,360.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,857.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,560.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,271.23
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,466.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,466.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,887.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,084.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,913.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,913.30
|
| Rate for Payer: Multiplan Commercial |
$13,615.20
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,466.15
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
IP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
915357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,501.00 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$22,799.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,432.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
OP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
915357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27,359.04 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$46,738.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,697.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85,497.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,026.48
|
| Rate for Payer: Blue Shield of California Commercial |
$84,129.05
|
| Rate for Payer: Blue Shield of California EPN |
$55,402.06
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$96,896.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,400.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,989.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,797.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,797.20
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Senior |
$96,896.60
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
IP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,501.00 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$22,799.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,432.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
OP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27,359.04 |
| Max. Negotiated Rate |
$96,896.60 |
| Rate for Payer: Adventist Health Commercial |
$46,738.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,697.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85,497.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,026.48
|
| Rate for Payer: Blue Shield of California Commercial |
$84,129.05
|
| Rate for Payer: Blue Shield of California EPN |
$55,402.06
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$96,896.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,400.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,989.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,359.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,797.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,797.20
|
| Rate for Payer: Multiplan Commercial |
$91,196.80
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Senior |
$96,896.60
|
|
