|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
905356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.42 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.33
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
915356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.42 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.33
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
915356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: Adventist Health Commercial |
$285.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$405.44
|
| Rate for Payer: Blue Shield of California Commercial |
$558.99
|
| Rate for Payer: Blue Shield of California EPN |
$351.29
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$592.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$442.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$487.90
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
905356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Blue Shield of California Commercial |
$558.99
|
| Rate for Payer: Blue Shield of California EPN |
$351.29
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$442.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
915356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$139.40
|
| Rate for Payer: Blue Shield of California Commercial |
$558.99
|
| Rate for Payer: Blue Shield of California EPN |
$351.29
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$442.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$453.05
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
905356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.20 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Adventist Health Commercial |
$285.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$405.44
|
| Rate for Payer: Blue Shield of California Commercial |
$558.99
|
| Rate for Payer: Blue Shield of California EPN |
$351.29
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$592.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$442.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$487.90
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.58
|
| Rate for Payer: United Healthcare All Other HMO |
$254.61
|
| Rate for Payer: United Healthcare HMO Rider |
$249.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
905356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Blue Shield of California Commercial |
$362.50
|
| Rate for Payer: Blue Shield of California EPN |
$227.81
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
915356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Blue Shield of California Commercial |
$362.50
|
| Rate for Payer: Blue Shield of California EPN |
$227.81
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
905356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.05 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$185.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.93
|
| Rate for Payer: Blue Shield of California Commercial |
$362.50
|
| Rate for Payer: Blue Shield of California EPN |
$227.81
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$384.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Riverside University Health System MISP |
$180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
915356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.05 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$185.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.93
|
| Rate for Payer: Blue Shield of California Commercial |
$362.50
|
| Rate for Payer: Blue Shield of California EPN |
$227.81
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$384.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$135.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Riverside University Health System MISP |
$180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.64
|
| Rate for Payer: United Healthcare All Other HMO |
$165.12
|
| Rate for Payer: United Healthcare HMO Rider |
$161.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC UE ADD HOOK TO HAND CABLE ADAP
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
915356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC UE ADD HOOK TO HAND CABLE ADAP
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
905356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
HC UE ADD HOOK TO HAND CABLE ADAP
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
905356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.33
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HOOK TO HAND CABLE ADAP
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
915356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.33
|
| Rate for Payer: Blue Shield of California Commercial |
$125.91
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.90
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADDITION ELBOW LIFT ASSIST
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
915356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.94 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: Adventist Health Commercial |
$322.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.80
|
| Rate for Payer: Blue Shield of California Commercial |
$631.17
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$550.90
|
| Rate for Payer: Cigna of CA PPO |
$550.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$393.50
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Riverside University Health System MISP |
$314.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC UE ADDITION ELBOW LIFT ASSIST
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
905356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.94 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$322.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.80
|
| Rate for Payer: Blue Shield of California Commercial |
$631.17
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$550.90
|
| Rate for Payer: Cigna of CA PPO |
$550.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$393.50
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Riverside University Health System MISP |
$314.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC UE ADDITION ELBOW LIFT ASSIST
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
915356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Blue Shield of California Commercial |
$631.17
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$550.90
|
| Rate for Payer: Cigna of CA PPO |
$550.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
|
|
HC UE ADDITION ELBOW LIFT ASSIST
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
905356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Blue Shield of California Commercial |
$631.17
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$550.90
|
| Rate for Payer: Cigna of CA PPO |
$550.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
915356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.80
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
905356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.80
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
905356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.39
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.30
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Riverside University Health System MISP |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
915356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.39
|
| Rate for Payer: Blue Shield of California Commercial |
$175.64
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$110.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$139.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$122.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$153.30
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Riverside University Health System MISP |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
915356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Blue Shield of California Commercial |
$230.98
|
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$201.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.09
|
| Rate for Payer: United Healthcare All Other HMO |
$105.21
|
| Rate for Payer: United Healthcare HMO Rider |
$102.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.32
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
905356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$118.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.53
|
| Rate for Payer: Blue Shield of California Commercial |
$230.98
|
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$201.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$144.00
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Riverside University Health System MISP |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.09
|
| Rate for Payer: United Healthcare All Other HMO |
$105.21
|
| Rate for Payer: United Healthcare HMO Rider |
$102.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
915356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Adventist Health Commercial |
$118.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.53
|
| Rate for Payer: Blue Shield of California Commercial |
$230.98
|
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$201.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$144.00
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Riverside University Health System MISP |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.09
|
| Rate for Payer: United Healthcare All Other HMO |
$105.21
|
| Rate for Payer: United Healthcare HMO Rider |
$102.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
