|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
|
OP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
905356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,677.45 |
| Max. Negotiated Rate |
$4,609.80 |
| Rate for Payer: Adventist Health Commercial |
$2,100.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,817.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,979.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,107.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,581.49
|
| Rate for Payer: Cash Price |
$2,304.90
|
| Rate for Payer: Cash Price |
$2,304.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,097.60
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,353.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,353.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,585.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,048.80
|
| Rate for Payer: Galaxy Health WC |
$4,353.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,073.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,609.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,523.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,252.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,892.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,021.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,585.40
|
| Rate for Payer: Multiplan Commercial |
$3,841.50
|
| Rate for Payer: Networks By Design Commercial |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,048.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,073.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,073.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,677.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,353.70
|
|
|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
|
IP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
905356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,024.40 |
| Max. Negotiated Rate |
$4,609.80 |
| Rate for Payer: Adventist Health Commercial |
$1,024.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,107.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,581.49
|
| Rate for Payer: Cash Price |
$2,304.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,097.60
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,585.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,048.80
|
| Rate for Payer: Galaxy Health WC |
$4,353.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,073.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,609.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,252.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,021.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,024.40
|
| Rate for Payer: Multiplan Commercial |
$3,841.50
|
| Rate for Payer: Networks By Design Commercial |
$3,329.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,677.45
|
|
|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
|
OP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
915356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,677.45 |
| Max. Negotiated Rate |
$4,609.80 |
| Rate for Payer: Adventist Health Commercial |
$2,100.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,817.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,979.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,107.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,581.49
|
| Rate for Payer: Cash Price |
$2,304.90
|
| Rate for Payer: Cash Price |
$2,304.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,097.60
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,353.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,353.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,585.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,048.80
|
| Rate for Payer: Galaxy Health WC |
$4,353.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,073.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,609.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,523.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,252.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,892.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,021.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,585.40
|
| Rate for Payer: Multiplan Commercial |
$3,841.50
|
| Rate for Payer: Networks By Design Commercial |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: Riverside University Health System MISP |
$2,048.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,073.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,073.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,922.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,871.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,677.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,353.70
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
915356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.67 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.85
|
| Rate for Payer: Blue Shield of California Commercial |
$523.71
|
| Rate for Payer: Blue Shield of California EPN |
$329.11
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Riverside University Health System MISP |
$261.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
915356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Blue Shield of California Commercial |
$523.71
|
| Rate for Payer: Blue Shield of California EPN |
$329.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.60
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
905356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$188.67 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.85
|
| Rate for Payer: Blue Shield of California Commercial |
$523.71
|
| Rate for Payer: Blue Shield of California EPN |
$329.11
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$188.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$208.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Riverside University Health System MISP |
$261.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
905356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Blue Shield of California Commercial |
$523.71
|
| Rate for Payer: Blue Shield of California EPN |
$329.11
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.60
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
915356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
905356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.37 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.42
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health System MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
915356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.37 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.42
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health System MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
905356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
905356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.62 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.42
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health System MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
915356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.62 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.42
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health System MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
915356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
905356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$735.43
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$582.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$541.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
905356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.20 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Adventist Health Commercial |
$311.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.91
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$988.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$918.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$1,011.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
915356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.20 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: Adventist Health Commercial |
$311.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.91
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$988.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$918.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$1,011.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
905356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.37 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Adventist Health Commercial |
$637.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,167.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$905.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.91
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,322.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,322.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$426.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$988.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$470.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$918.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,089.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$778.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: Riverside University Health System MISP |
$622.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,322.60
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
915356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.37 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Adventist Health Commercial |
$637.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,167.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$905.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.91
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,322.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,322.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$426.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$988.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$470.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$918.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,089.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$778.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: Riverside University Health System MISP |
$622.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,322.60
|
|
|
HC UE ADD STNDRD CONTL CABLE EX
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
915356655
|
|
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 ADD STNDRD CONTL CABLE EX
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
915356655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.09 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Networks By Design Commercial |
$144.00
|
| 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 |
$55.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.86
|
| 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: 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 ADD STNDRD CONTL CABLE EX
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
905356655
|
|
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 ADD STNDRD CONTL CABLE EX
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
905356655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.09 |
| 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 |
$55.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.86
|
| 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 ADD STNLESS STEEL ANY WRIST
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
915356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Blue Shield of California Commercial |
$290.32
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$213.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
|
|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
915356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$148.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$271.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.58
|
| Rate for Payer: Blue Shield of California Commercial |
$290.32
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$307.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$307.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$229.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$213.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$253.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$181.00
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Riverside University Health System MISP |
$144.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$307.70
|
| Rate for Payer: Vantage Medical Group Senior |
$307.70
|
|
