|
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 SILICONE GEL INSRT
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
915356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,367.41
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.00
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$1,108.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
915356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$558.39 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Adventist Health Commercial |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$937.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,367.41
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,449.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,449.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$710.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$784.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Riverside University Health System MISP |
$682.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,449.25
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,367.41
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.00
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$1,108.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$558.39 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Adventist Health Commercial |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$937.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$991.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,367.41
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,449.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,449.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$710.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,082.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$784.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,005.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Riverside University Health System MISP |
$682.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,449.25
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.24
|
| Rate for Payer: Blue Shield of California Commercial |
$208.52
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$221.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Riverside University Health System MISP |
$104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
915356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.24
|
| Rate for Payer: Blue Shield of California Commercial |
$208.52
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$221.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Riverside University Health System MISP |
$104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
915356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Blue Shield of California Commercial |
$208.52
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Blue Shield of California Commercial |
$208.52
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$544.30 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Adventist Health Commercial |
$681.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,246.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$966.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,332.92
|
| Rate for Payer: Blue Shield of California EPN |
$837.65
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,412.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,412.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$627.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$693.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,163.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Riverside University Health System MISP |
$664.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,412.70
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
905356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,332.92
|
| Rate for Payer: Blue Shield of California EPN |
$837.65
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,332.92
|
| Rate for Payer: Blue Shield of California EPN |
$837.65
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
905356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$544.30 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Adventist Health Commercial |
$681.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,246.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$966.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,332.92
|
| Rate for Payer: Blue Shield of California EPN |
$837.65
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,412.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,412.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$627.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,055.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$693.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$980.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,163.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Riverside University Health System MISP |
$664.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,412.70
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.06
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Riverside University Health System MISP |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.06
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Riverside University Health System MISP |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$93.83
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$74.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$69.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.23 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.94
|
| Rate for Payer: Blue Shield of California Commercial |
$563.81
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health System MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Blue Shield of California Commercial |
$563.81
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.23 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.94
|
| Rate for Payer: Blue Shield of California Commercial |
$563.81
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health System MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Blue Shield of California Commercial |
$563.81
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$446.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$414.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,158.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$2,559.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,158.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$2,559.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,289.69 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,158.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,709.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,575.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,289.69 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,290.73
|
| Rate for Payer: Blue Shield of California Commercial |
$3,158.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,709.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,500.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,323.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,575.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
