|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
OP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.75 |
| Max. Negotiated Rate |
$2,473.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,473.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$937.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$937.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$825.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,007.31
|
| Rate for Payer: BCBS Transplant Transplant |
$1,023.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,278.75
|
| Rate for Payer: Blue Shield of California EPN |
$927.52
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,449.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,278.75
|
| Rate for Payer: IEHP medi-cal |
$596.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.05
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Riverside University Health MISP |
$682.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$852.50
|
| Rate for Payer: United Healthcare All Other HMO |
$852.50
|
| Rate for Payer: United Healthcare HMO Rider |
$852.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$852.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,449.25
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
IP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Blue Shield of California EPN |
$910.47
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.00
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Blue Shield of California EPN |
$138.84
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$819.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$819.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$125.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$153.61
|
| Rate for Payer: BCBS Transplant Transplant |
$156.00
|
| Rate for Payer: Blue Shield of California Commercial |
$195.00
|
| Rate for Payer: Blue Shield of California EPN |
$141.44
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$195.00
|
| Rate for Payer: IEHP medi-cal |
$91.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.60
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Riverside University Health MISP |
$104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.00
|
| Rate for Payer: United Healthcare All Other HMO |
$130.00
|
| Rate for Payer: United Healthcare HMO Rider |
$130.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$130.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
OP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
905356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$581.70 |
| Max. Negotiated Rate |
$2,611.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,611.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$914.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$914.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$804.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$981.91
|
| Rate for Payer: BCBS Transplant Transplant |
$997.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,246.50
|
| Rate for Payer: Blue Shield of California EPN |
$904.13
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,246.50
|
| Rate for Payer: IEHP medi-cal |
$581.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.42
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Riverside University Health MISP |
$664.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$831.00
|
| Rate for Payer: United Healthcare All Other HMO |
$831.00
|
| Rate for Payer: United Healthcare HMO Rider |
$831.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$831.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,412.70
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
905356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Blue Shield of California EPN |
$887.51
|
| Rate for Payer: Cash Price |
$747.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,329.60
|
| Rate for Payer: Cigna of CA HMO |
$1,163.40
|
| Rate for Payer: Cigna of CA PPO |
$1,163.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$287.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$287.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$64.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.12
|
| Rate for Payer: BCBS Transplant Transplant |
$70.20
|
| Rate for Payer: Blue Shield of California Commercial |
$87.75
|
| Rate for Payer: Blue Shield of California EPN |
$63.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$87.75
|
| Rate for Payer: IEHP medi-cal |
$40.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Riverside University Health MISP |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.50
|
| Rate for Payer: United Healthcare All Other HMO |
$58.50
|
| Rate for Payer: United Healthcare HMO Rider |
$58.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Blue Shield of California EPN |
$62.48
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Blue Shield of California EPN |
$375.40
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.05 |
| Max. Negotiated Rate |
$1,624.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,624.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$386.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$340.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.33
|
| Rate for Payer: BCBS Transplant Transplant |
$421.80
|
| Rate for Payer: Blue Shield of California Commercial |
$527.25
|
| Rate for Payer: Blue Shield of California EPN |
$382.43
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Cash Price |
$316.35
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$527.25
|
| Rate for Payer: IEHP medi-cal |
$246.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.50
|
| Rate for Payer: United Healthcare All Other HMO |
$351.50
|
| Rate for Payer: United Healthcare HMO Rider |
$351.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Blue Shield of California EPN |
$2,102.89
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,378.30 |
| Max. Negotiated Rate |
$9,938.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,938.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,165.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,906.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,326.57
|
| Rate for Payer: BCBS Transplant Transplant |
$2,362.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,953.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,142.27
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Cash Price |
$1,772.10
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,953.50
|
| Rate for Payer: IEHP medi-cal |
$1,378.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.58
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Riverside University Health MISP |
$1,575.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,969.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,969.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
IP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
905356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Blue Shield of California EPN |
$542.54
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.20
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
OP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
905356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$355.60 |
| Max. Negotiated Rate |
$2,118.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,118.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$558.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$558.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$491.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$600.25
|
| Rate for Payer: BCBS Transplant Transplant |
$609.60
|
| Rate for Payer: Blue Shield of California Commercial |
$762.00
|
| Rate for Payer: Blue Shield of California EPN |
$552.70
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$863.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$762.00
|
| Rate for Payer: IEHP medi-cal |
$355.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.56
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: Riverside University Health MISP |
$406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$508.00
|
| Rate for Payer: United Healthcare All Other HMO |
$508.00
|
| Rate for Payer: United Healthcare HMO Rider |
$508.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.60
|
| Rate for Payer: Vantage Medical Group Senior |
$863.60
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
OP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
905356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.90 |
| Max. Negotiated Rate |
$647.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$647.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$260.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$229.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.04
|
| Rate for Payer: BCBS Transplant Transplant |
$284.40
|
| Rate for Payer: Blue Shield of California Commercial |
$355.50
|
| Rate for Payer: Blue Shield of California EPN |
$257.86
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$355.50
|
| Rate for Payer: IEHP medi-cal |
$165.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.34
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Riverside University Health MISP |
$189.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.00
|
| Rate for Payer: United Healthcare All Other HMO |
$237.00
|
| Rate for Payer: United Healthcare HMO Rider |
$237.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
IP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
905356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Blue Shield of California EPN |
$253.12
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
OP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
905356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$1,526.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,526.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$262.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$262.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.40
|
| Rate for Payer: BCBS Transplant Transplant |
$286.80
|
| Rate for Payer: Blue Shield of California Commercial |
$358.50
|
| Rate for Payer: Blue Shield of California EPN |
$260.03
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$358.50
|
| Rate for Payer: IEHP medi-cal |
$167.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: Riverside University Health MISP |
$191.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.00
|
| Rate for Payer: United Healthcare All Other HMO |
$239.00
|
| Rate for Payer: United Healthcare HMO Rider |
$239.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.30
|
| Rate for Payer: Vantage Medical Group Senior |
$406.30
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
IP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
905356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Blue Shield of California EPN |
$255.25
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.60
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
|
|
HC UE ADD ROTAT WRIST W/CABLE LCK
|
Facility
OP
|
$2,862.00
|
|
|
Service Code
|
CPT L6625
|
| Hospital Charge Code |
905356625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,001.70 |
| Max. Negotiated Rate |
$2,575.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,352.37
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,432.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,574.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,574.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,385.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,690.87
|
| Rate for Payer: BCBS Transplant Transplant |
$1,717.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,146.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.93
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,289.60
|
| Rate for Payer: Cigna of CA HMO |
$2,003.40
|
| Rate for Payer: Cigna of CA PPO |
$2,003.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,432.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,144.80
|
| Rate for Payer: Galaxy Health WC |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,575.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,146.50
|
| Rate for Payer: IEHP medi-cal |
$1,001.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,173.42
|
| Rate for Payer: Multiplan Commercial |
$2,146.50
|
| Rate for Payer: Networks By Design Commercial |
$1,431.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
| Rate for Payer: Riverside University Health MISP |
$1,144.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,717.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,717.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,431.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,431.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,431.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,431.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,432.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,432.70
|
|
|
HC UE ADD ROTAT WRIST W/CABLE LCK
|
Facility
IP
|
$2,862.00
|
|
|
Service Code
|
CPT L6625
|
| Hospital Charge Code |
905356625
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$2,575.80 |
| Rate for Payer: Blue Shield of California EPN |
$1,528.31
|
| Rate for Payer: Cash Price |
$1,287.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,289.60
|
| Rate for Payer: Cigna of CA HMO |
$2,003.40
|
| Rate for Payer: Cigna of CA PPO |
$2,003.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,144.80
|
| Rate for Payer: Galaxy Health WC |
$2,432.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,575.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,908.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Multiplan Commercial |
$2,146.50
|
| Rate for Payer: Networks By Design Commercial |
$1,431.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,432.70
|
|
|
HC UE ADD SHLDR JNT MULTIPOS LOCK
|
Facility
OP
|
$4,966.00
|
|
|
Service Code
|
CPT L6646
|
| Hospital Charge Code |
905356646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,738.10 |
| Max. Negotiated Rate |
$12,534.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,534.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,221.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,731.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,731.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,404.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,933.91
|
| Rate for Payer: BCBS Transplant Transplant |
$2,979.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,724.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,701.50
|
| Rate for Payer: Cash Price |
$2,234.70
|
| Rate for Payer: Cash Price |
$2,234.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.80
|
| Rate for Payer: Cigna of CA HMO |
$3,476.20
|
| Rate for Payer: Cigna of CA PPO |
$3,476.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,221.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,986.40
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,469.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,724.50
|
| Rate for Payer: IEHP medi-cal |
$1,738.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,312.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,036.06
|
| Rate for Payer: Multiplan Commercial |
$3,724.50
|
| Rate for Payer: Networks By Design Commercial |
$2,483.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
| Rate for Payer: Riverside University Health MISP |
$1,986.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,979.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,979.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,483.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,483.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,483.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,483.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,221.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,221.10
|
|
|
HC UE ADD SHLDR JNT MULTIPOS LOCK
|
Facility
IP
|
$4,966.00
|
|
|
Service Code
|
CPT L6646
|
| Hospital Charge Code |
905356646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$993.20 |
| Max. Negotiated Rate |
$4,469.40 |
| Rate for Payer: Blue Shield of California EPN |
$2,651.84
|
| Rate for Payer: Cash Price |
$2,234.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,972.80
|
| Rate for Payer: Cigna of CA HMO |
$3,476.20
|
| Rate for Payer: Cigna of CA PPO |
$3,476.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,986.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,986.40
|
| Rate for Payer: Galaxy Health WC |
$4,221.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,979.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,469.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,312.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.20
|
| Rate for Payer: Multiplan Commercial |
$3,724.50
|
| Rate for Payer: Networks By Design Commercial |
$2,483.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,221.10
|
|
|
HC UE ADD SHLDR LOCK BODY-POWERED
|
Facility
OP
|
$818.00
|
|
|
Service Code
|
CPT L6647
|
| Hospital Charge Code |
905356647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.30 |
| Max. Negotiated Rate |
$2,063.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,063.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$695.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$449.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$449.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$396.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$483.27
|
| Rate for Payer: BCBS Transplant Transplant |
$490.80
|
| Rate for Payer: Blue Shield of California Commercial |
$613.50
|
| Rate for Payer: Blue Shield of California EPN |
$444.99
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Central Health Plan Commercial |
$654.40
|
| Rate for Payer: Cigna of CA HMO |
$572.60
|
| Rate for Payer: Cigna of CA PPO |
$572.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$736.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$613.50
|
| Rate for Payer: IEHP medi-cal |
$286.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.38
|
| Rate for Payer: Multiplan Commercial |
$613.50
|
| Rate for Payer: Networks By Design Commercial |
$409.00
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
| Rate for Payer: Riverside University Health MISP |
$327.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$490.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$490.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.00
|
| Rate for Payer: United Healthcare All Other HMO |
$409.00
|
| Rate for Payer: United Healthcare HMO Rider |
$409.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$695.30
|
| Rate for Payer: Vantage Medical Group Senior |
$695.30
|
|
|
HC UE ADD SHLDR LOCK BODY-POWERED
|
Facility
IP
|
$818.00
|
|
|
Service Code
|
CPT L6647
|
| Hospital Charge Code |
905356647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.60 |
| Max. Negotiated Rate |
$736.20 |
| Rate for Payer: Blue Shield of California EPN |
$436.81
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Central Health Plan Commercial |
$654.40
|
| Rate for Payer: Cigna of CA HMO |
$572.60
|
| Rate for Payer: Cigna of CA PPO |
$572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$327.20
|
| Rate for Payer: Galaxy Health WC |
$695.30
|
| Rate for Payer: Global Benefits Group Commercial |
$490.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$736.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$545.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.60
|
| Rate for Payer: Multiplan Commercial |
$613.50
|
| Rate for Payer: Networks By Design Commercial |
$409.00
|
| Rate for Payer: Prime Health Services Commercial |
$695.30
|
|
|
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: Blue Shield of California EPN |
$2,735.15
|
| 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: EPIC Health Plan Commercial |
$2,048.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$3,416.37
|
| 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 |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
|
