|
HC U1RNP AUTO AB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913524
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$135.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.13
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: InnovAge PACE Commercial |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
905356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Shield of California EPN |
$304.38
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.23
|
| Rate for Payer: United Healthcare All Other HMO |
$210.22
|
| Rate for Payer: United Healthcare HMO Rider |
$205.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.10
|
|
|
HC UE ADD DISCON LOCK WRIST UNIT
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6615
|
| Hospital Charge Code |
905356615
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.32 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$275.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.76
|
| Rate for Payer: Blue Distinction Transplant |
$342.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.50
|
| Rate for Payer: Blue Shield of California EPN |
$310.08
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Media |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$427.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.70
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Riverside University Health System MISP |
$228.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$285.00
|
| Rate for Payer: United Healthcare HMO Rider |
$285.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
905356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.95 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.10
|
| Rate for Payer: Blue Distinction Transplant |
$202.20
|
| Rate for Payer: Blue Shield of California Commercial |
$252.75
|
| Rate for Payer: Blue Shield of California EPN |
$183.33
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Central Health Plan Commercial |
$269.60
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Media |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$303.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$252.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$117.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.17
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Riverside University Health System MISP |
$134.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.50
|
| Rate for Payer: United Healthcare All Other HMO |
$168.50
|
| Rate for Payer: United Healthcare HMO Rider |
$168.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC UE ADD EXCUR AMPL LEVER TYPE
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT L6642
|
| Hospital Charge Code |
905356642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Blue Shield of California EPN |
$179.96
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Central Health Plan Commercial |
$269.60
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$303.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.40
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.25
|
| Rate for Payer: United Healthcare All Other HMO |
$124.29
|
| Rate for Payer: United Healthcare HMO Rider |
$121.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.21
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
905356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Blue Shield of California EPN |
$254.72
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Central Health Plan Commercial |
$381.60
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.40
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.12
|
| Rate for Payer: United Healthcare All Other HMO |
$175.92
|
| Rate for Payer: United Healthcare HMO Rider |
$172.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.41
|
|
|
HC UE ADD EXCUR AMP PULLEY TYPE
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT L6641
|
| Hospital Charge Code |
905356641
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.95 |
| Max. Negotiated Rate |
$429.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.81
|
| Rate for Payer: Blue Distinction Transplant |
$286.20
|
| Rate for Payer: Blue Shield of California Commercial |
$357.75
|
| Rate for Payer: Blue Shield of California EPN |
$259.49
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Cash Price |
$214.65
|
| Rate for Payer: Central Health Plan Commercial |
$381.60
|
| Rate for Payer: Cigna of CA HMO |
$333.90
|
| Rate for Payer: Cigna of CA PPO |
$333.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.45
|
| Rate for Payer: Dignity Health Media |
$405.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$190.80
|
| Rate for Payer: Galaxy Health WC |
$405.45
|
| Rate for Payer: Global Benefits Group Commercial |
$286.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$429.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$357.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.57
|
| Rate for Payer: Multiplan Commercial |
$357.75
|
| Rate for Payer: Networks By Design Commercial |
$238.50
|
| Rate for Payer: Prime Health Services Commercial |
$405.45
|
| Rate for Payer: Riverside University Health System MISP |
$190.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.50
|
| Rate for Payer: United Healthcare All Other HMO |
$238.50
|
| Rate for Payer: United Healthcare HMO Rider |
$238.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$238.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.45
|
| Rate for Payer: Vantage Medical Group Senior |
$405.45
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
OP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
905356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$283.65 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$956.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$618.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$618.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$544.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$664.65
|
| Rate for Payer: Blue Distinction Transplant |
$675.00
|
| Rate for Payer: Blue Shield of California Commercial |
$843.75
|
| Rate for Payer: Blue Shield of California EPN |
$612.00
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Central Health Plan Commercial |
$900.00
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$956.25
|
| Rate for Payer: Dignity Health Media |
$956.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$956.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,012.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$843.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$393.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.25
|
| Rate for Payer: Multiplan Commercial |
$843.75
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: Riverside University Health System MISP |
$450.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$675.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$956.25
|
| Rate for Payer: Vantage Medical Group Senior |
$956.25
|
|
|
HC UE ADD FLEXION FRICTION WRIST
|
Facility
|
IP
|
$1,125.00
|
|
|
Service Code
|
CPT L6620
|
| Hospital Charge Code |
905356620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$225.00 |
| Max. Negotiated Rate |
$1,012.50 |
| Rate for Payer: Blue Shield of California EPN |
$600.75
|
| Rate for Payer: Cash Price |
$506.25
|
| Rate for Payer: Central Health Plan Commercial |
$900.00
|
| Rate for Payer: Cigna of CA HMO |
$787.50
|
| Rate for Payer: Cigna of CA PPO |
$787.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$450.00
|
| Rate for Payer: Galaxy Health WC |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$675.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,012.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$750.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$843.75
|
| Rate for Payer: Networks By Design Commercial |
$562.50
|
| Rate for Payer: Prime Health Services Commercial |
$956.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$424.80
|
| Rate for Payer: United Healthcare All Other HMO |
$414.90
|
| Rate for Payer: United Healthcare HMO Rider |
$405.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$371.25
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
OP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
905356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$147.67 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$484.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$275.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$336.76
|
| Rate for Payer: Blue Distinction Transplant |
$342.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.50
|
| Rate for Payer: Blue Shield of California EPN |
$310.08
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$484.50
|
| Rate for Payer: Dignity Health Media |
$484.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$484.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$427.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$199.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.70
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: Riverside University Health System MISP |
$228.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$342.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$285.00
|
| Rate for Payer: United Healthcare HMO Rider |
$285.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$484.50
|
| Rate for Payer: Vantage Medical Group Senior |
$484.50
|
|
|
HC UE ADD HAMESS FIG 8 DUAL CONTR
|
Facility
|
IP
|
$570.00
|
|
|
Service Code
|
CPT L6676
|
| Hospital Charge Code |
905356676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.00 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Blue Shield of California EPN |
$304.38
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Central Health Plan Commercial |
$456.00
|
| Rate for Payer: Cigna of CA HMO |
$399.00
|
| Rate for Payer: Cigna of CA PPO |
$399.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$228.00
|
| Rate for Payer: Galaxy Health WC |
$484.50
|
| Rate for Payer: Global Benefits Group Commercial |
$342.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$427.50
|
| Rate for Payer: Networks By Design Commercial |
$285.00
|
| Rate for Payer: Prime Health Services Commercial |
$484.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.23
|
| Rate for Payer: United Healthcare All Other HMO |
$210.22
|
| Rate for Payer: United Healthcare HMO Rider |
$205.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.10
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
905356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.76
|
| Rate for Payer: Blue Distinction Transplant |
$94.20
|
| Rate for Payer: Blue Shield of California Commercial |
$117.75
|
| Rate for Payer: Blue Shield of California EPN |
$85.41
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Media |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.50
|
| Rate for Payer: United Healthcare All Other HMO |
$78.50
|
| Rate for Payer: United Healthcare HMO Rider |
$78.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HAMESS FIG 8 SNGL CONTR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6675
|
| Hospital Charge Code |
905356675
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Blue Shield of California EPN |
$83.84
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.28
|
| Rate for Payer: United Healthcare All Other HMO |
$57.90
|
| Rate for Payer: United Healthcare HMO Rider |
$56.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.81
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
905356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.06 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$383.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$337.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.79
|
| Rate for Payer: Blue Distinction Transplant |
$418.20
|
| Rate for Payer: Blue Shield of California Commercial |
$522.75
|
| Rate for Payer: Blue Shield of California EPN |
$379.17
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.45
|
| Rate for Payer: Dignity Health Media |
$592.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$592.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$522.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.77
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: Riverside University Health System MISP |
$278.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other HMO |
$348.50
|
| Rate for Payer: United Healthcare HMO Rider |
$348.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$592.45
|
| Rate for Payer: Vantage Medical Group Senior |
$592.45
|
|
|
HC UE ADD HAMESS SADDLE TYPE
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT L6672
|
| Hospital Charge Code |
905356672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.40 |
| Max. Negotiated Rate |
$627.30 |
| Rate for Payer: Blue Shield of California EPN |
$372.20
|
| Rate for Payer: Cash Price |
$313.65
|
| Rate for Payer: Central Health Plan Commercial |
$557.60
|
| Rate for Payer: Cigna of CA HMO |
$487.90
|
| Rate for Payer: Cigna of CA PPO |
$487.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$592.45
|
| Rate for Payer: Global Benefits Group Commercial |
$418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$627.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$464.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.40
|
| Rate for Payer: Multiplan Commercial |
$522.75
|
| Rate for Payer: Networks By Design Commercial |
$348.50
|
| Rate for Payer: Prime Health Services Commercial |
$592.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.19
|
| Rate for Payer: United Healthcare All Other HMO |
$257.05
|
| Rate for Payer: United Healthcare HMO Rider |
$251.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.01
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
905356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Blue Shield of California EPN |
$241.37
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$170.68
|
| Rate for Payer: United Healthcare All Other HMO |
$166.70
|
| Rate for Payer: United Healthcare HMO Rider |
$163.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.16
|
|
|
HC UE ADD HEAVY DUTY CONTRL CABLE
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT L6660
|
| Hospital Charge Code |
905356660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.19 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.04
|
| Rate for Payer: Blue Distinction Transplant |
$271.20
|
| Rate for Payer: Blue Shield of California Commercial |
$339.00
|
| Rate for Payer: Blue Shield of California EPN |
$245.89
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$316.40
|
| Rate for Payer: Cigna of CA PPO |
$316.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Media |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$339.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.32
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$226.00
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Riverside University Health System MISP |
$180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC UE ADD HOOK TO HAND CABLE ADAP
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
905356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$76.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.76
|
| Rate for Payer: Blue Distinction Transplant |
$94.20
|
| Rate for Payer: Blue Shield of California Commercial |
$117.75
|
| Rate for Payer: Blue Shield of California EPN |
$85.41
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$133.45
|
| Rate for Payer: Dignity Health Media |
$133.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Riverside University Health System MISP |
$62.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.50
|
| Rate for Payer: United Healthcare All Other HMO |
$78.50
|
| Rate for Payer: United Healthcare HMO Rider |
$78.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$78.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
HC UE ADD HOOK TO HAND CABLE ADAP
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
905356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Blue Shield of California EPN |
$83.84
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Central Health Plan Commercial |
$125.60
|
| Rate for Payer: Cigna of CA HMO |
$109.90
|
| Rate for Payer: Cigna of CA PPO |
$109.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$141.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.40
|
| Rate for Payer: Multiplan Commercial |
$117.75
|
| Rate for Payer: Networks By Design Commercial |
$78.50
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.28
|
| Rate for Payer: United Healthcare All Other HMO |
$57.90
|
| Rate for Payer: United Healthcare HMO Rider |
$56.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.81
|
|
|
HC UE ADDITION ELBOW LIFT ASSIST
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
905356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$218.65 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$432.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$464.96
|
| Rate for Payer: Blue Distinction Transplant |
$472.20
|
| Rate for Payer: Blue Shield of California Commercial |
$590.25
|
| Rate for Payer: Blue Shield of California EPN |
$428.13
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$550.90
|
| Rate for Payer: Cigna of CA PPO |
$550.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Media |
$668.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$590.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$275.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.67
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$393.50
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Riverside University Health System MISP |
$314.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.50
|
| Rate for Payer: United Healthcare All Other HMO |
$393.50
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC UE ADDITION ELBOW LIFT ASSIST
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
905356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Blue Shield of California EPN |
$420.26
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$550.90
|
| Rate for Payer: Cigna of CA PPO |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$393.50
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.17
|
| Rate for Payer: United Healthcare All Other HMO |
$290.25
|
| Rate for Payer: United Healthcare HMO Rider |
$283.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.71
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
905356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Blue Shield of California EPN |
$116.95
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.80
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.69
|
| Rate for Payer: United Healthcare All Other HMO |
$80.77
|
| Rate for Payer: United Healthcare HMO Rider |
$79.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.27
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
905356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.65 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$120.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$120.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.39
|
| Rate for Payer: Blue Distinction Transplant |
$131.40
|
| Rate for Payer: Blue Shield of California Commercial |
$164.25
|
| Rate for Payer: Blue Shield of California EPN |
$119.14
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Central Health Plan Commercial |
$175.20
|
| Rate for Payer: Cigna of CA HMO |
$153.30
|
| Rate for Payer: Cigna of CA PPO |
$153.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$186.15
|
| Rate for Payer: Dignity Health Media |
$186.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$87.60
|
| Rate for Payer: Galaxy Health WC |
$186.15
|
| Rate for Payer: Global Benefits Group Commercial |
$131.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$197.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$164.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Multiplan Commercial |
$164.25
|
| Rate for Payer: Networks By Design Commercial |
$109.50
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: Riverside University Health System MISP |
$87.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$131.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$131.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.50
|
| Rate for Payer: United Healthcare All Other HMO |
$109.50
|
| Rate for Payer: United Healthcare HMO Rider |
$109.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$109.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
905356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Blue Shield of California EPN |
$153.79
|
| 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: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| 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 |
$144.00
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.75
|
| Rate for Payer: United Healthcare All Other HMO |
$106.21
|
| Rate for Payer: United Healthcare HMO Rider |
$103.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.04
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
905356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$259.20 |
| 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 |
$158.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.15
|
| Rate for Payer: Blue Distinction Transplant |
$172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$216.00
|
| Rate for Payer: Blue Shield of California EPN |
$156.67
|
| 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 Media |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$216.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.08
|
| 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 |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
