|
HC UE ADD SHLDR LOCK ELECTRIC-POW
|
Facility
OP
|
$5,122.00
|
|
|
Service Code
|
CPT L6648
|
| Hospital Charge Code |
905356648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,792.70 |
| Max. Negotiated Rate |
$12,927.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,927.55
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$4,353.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,817.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,817.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,480.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,026.08
|
| Rate for Payer: BCBS Transplant Transplant |
$3,073.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,841.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,786.37
|
| Rate for Payer: Cash Price |
$2,304.90
|
| Rate for Payer: Cash Price |
$2,304.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,097.60
|
| Rate for Payer: Cigna of CA HMO |
$3,585.40
|
| Rate for Payer: Cigna of CA PPO |
$3,585.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,353.70
|
| Rate for Payer: 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: Health Plan of Nevada - Sierra Transplant Other |
$3,841.50
|
| Rate for Payer: IEHP medi-cal |
$1,792.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,416.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,100.02
|
| Rate for Payer: Multiplan Commercial |
$3,841.50
|
| Rate for Payer: Networks By Design Commercial |
$2,561.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,353.70
|
| Rate for Payer: Riverside University Health MISP |
$2,048.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,073.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,073.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,561.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,561.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,561.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,561.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,353.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,353.70
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
IP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
905356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Blue Shield of California EPN |
$348.70
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.60
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
|
|
HC UE ADD SHOULDER ABDUC JOINT PR
|
Facility
OP
|
$653.00
|
|
|
Service Code
|
CPT L6640
|
| Hospital Charge Code |
905356640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$1,238.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,238.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$359.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.79
|
| Rate for Payer: BCBS Transplant Transplant |
$391.80
|
| Rate for Payer: Blue Shield of California Commercial |
$489.75
|
| Rate for Payer: Blue Shield of California EPN |
$355.23
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$489.75
|
| Rate for Payer: IEHP medi-cal |
$228.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.73
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Riverside University Health MISP |
$261.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.50
|
| Rate for Payer: United Healthcare All Other HMO |
$326.50
|
| Rate for Payer: United Healthcare HMO Rider |
$326.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
OP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
905356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$1,411.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,411.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$504.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$444.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$541.76
|
| Rate for Payer: BCBS Transplant Transplant |
$550.20
|
| Rate for Payer: Blue Shield of California Commercial |
$687.75
|
| Rate for Payer: Blue Shield of California EPN |
$498.85
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$687.75
|
| Rate for Payer: IEHP medi-cal |
$320.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$458.50
|
| Rate for Payer: United Healthcare All Other HMO |
$458.50
|
| Rate for Payer: United Healthcare HMO Rider |
$458.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER FLEX-ABD JT EA
|
Facility
IP
|
$917.00
|
|
|
Service Code
|
CPT L6645
|
| Hospital Charge Code |
905356645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Blue Shield of California EPN |
$489.68
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
IP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
905356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Blue Shield of California EPN |
$489.68
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
OP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
905356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$1,497.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,497.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$504.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$444.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$541.76
|
| Rate for Payer: BCBS Transplant Transplant |
$550.20
|
| Rate for Payer: Blue Shield of California Commercial |
$687.75
|
| Rate for Payer: Blue Shield of California EPN |
$498.85
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$687.75
|
| Rate for Payer: IEHP medi-cal |
$320.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$458.50
|
| Rate for Payer: United Healthcare All Other HMO |
$458.50
|
| Rate for Payer: United Healthcare HMO Rider |
$458.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
OP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
905356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$2,837.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,837.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$855.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$855.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$753.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$919.28
|
| Rate for Payer: BCBS Transplant Transplant |
$933.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,167.00
|
| Rate for Payer: Blue Shield of California EPN |
$846.46
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,167.00
|
| Rate for Payer: IEHP medi-cal |
$544.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.96
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$778.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: Riverside University Health MISP |
$622.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$778.00
|
| Rate for Payer: United Healthcare All Other HMO |
$778.00
|
| Rate for Payer: United Healthcare HMO Rider |
$778.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$778.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,322.60
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
IP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
905356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.20 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Blue Shield of California EPN |
$830.90
|
| Rate for Payer: Cash Price |
$700.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$778.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
|
|
HC UE ADD STNDRD CONTL CABLE EX
|
Facility
OP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
905356655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$332.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$332.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$216.00
|
| Rate for Payer: IEHP medi-cal |
$100.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| 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 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
|
|
|
HC UE ADD STNDRD CONTL CABLE EX
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
905356655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: 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: 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
|
|
|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
OP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
905356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$953.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$953.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$199.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$199.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$175.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.87
|
| Rate for Payer: BCBS Transplant Transplant |
$217.20
|
| Rate for Payer: Blue Shield of California Commercial |
$271.50
|
| Rate for Payer: Blue Shield of California EPN |
$196.93
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$307.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$271.50
|
| Rate for Payer: IEHP medi-cal |
$126.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$241.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.42
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$181.00
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Riverside University Health MISP |
$144.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$181.00
|
| Rate for Payer: United Healthcare All Other HMO |
$181.00
|
| Rate for Payer: United Healthcare HMO Rider |
$181.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$181.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$307.70
|
| Rate for Payer: Vantage Medical Group Senior |
$307.70
|
|
|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
IP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
905356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Blue Shield of California EPN |
$193.31
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$241.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$181.00
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Blue Shield of California EPN |
$41.12
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$203.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$203.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$42.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.49
|
| Rate for Payer: BCBS Transplant Transplant |
$46.20
|
| Rate for Payer: Blue Shield of California Commercial |
$57.75
|
| Rate for Payer: Blue Shield of California EPN |
$41.89
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$57.75
|
| Rate for Payer: IEHP medi-cal |
$26.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Riverside University Health MISP |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.50
|
| Rate for Payer: United Healthcare All Other HMO |
$38.50
|
| Rate for Payer: United Healthcare HMO Rider |
$38.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
OP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$1,178.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,178.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$269.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$237.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.49
|
| Rate for Payer: BCBS Transplant Transplant |
$294.00
|
| Rate for Payer: Blue Shield of California Commercial |
$367.50
|
| Rate for Payer: Blue Shield of California EPN |
$266.56
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$367.50
|
| Rate for Payer: IEHP medi-cal |
$171.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Riverside University Health MISP |
$196.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.00
|
| Rate for Payer: United Healthcare All Other HMO |
$245.00
|
| Rate for Payer: United Healthcare HMO Rider |
$245.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$245.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
IP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Blue Shield of California EPN |
$261.66
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
IP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC UGI AIR DBL CONTRAST
|
Facility
OP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909001790
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.85
|
| Rate for Payer: BCBS Transplant Transplant |
$597.60
|
| Rate for Payer: Blue Shield of California Commercial |
$615.53
|
| Rate for Payer: Blue Shield of California EPN |
$484.06
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: IEHP medi-cal |
$378.77
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Innovage PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: Riverside University Health MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
|
|
HC ULTRASND OB LT 14 WK ADD FETUS
|
Facility
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
906601313
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$161.07 |
| Max. Negotiated Rate |
$16,107.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$163.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$694.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$161.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.18
|
| Rate for Payer: BCBS Transplant Transplant |
$757.80
|
| Rate for Payer: Blue Shield of California Commercial |
$780.53
|
| Rate for Payer: Blue Shield of California EPN |
$613.82
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$808.32
|
| Rate for Payer: Cigna of CA PPO |
$934.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$947.25
|
| Rate for Payer: IEHP medi-cal |
$442.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: Riverside University Health MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,107.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$335.20 |
| Max. Negotiated Rate |
$1,508.40 |
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,340.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.40
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,508.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.20
|
| Rate for Payer: Multiplan Commercial |
$1,257.00
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
|
|
HC ULTRASND OB LT 14 WK SNGL FETUS
|
Facility
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
906601314
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$24,656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$459.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$228.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.18
|
| Rate for Payer: BCBS Transplant Transplant |
$1,005.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,035.77
|
| Rate for Payer: Blue Shield of California EPN |
$814.54
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,340.80
|
| Rate for Payer: Cigna of CA HMO |
$1,072.64
|
| Rate for Payer: Cigna of CA PPO |
$1,240.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,508.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,257.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,257.00
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,005.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24,656.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
IP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$489.00 |
| Max. Negotiated Rate |
$2,200.50 |
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,200.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
|
|
HC ULTRASONIC GUIDEANCE/INTRAOP
|
Facility
OP
|
$2,445.00
|
|
|
Service Code
|
CPT 76998
|
| Hospital Charge Code |
906601555
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$330.96 |
| Max. Negotiated Rate |
$2,200.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$330.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,078.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,344.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,344.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$472.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,444.51
|
| Rate for Payer: BCBS Transplant Transplant |
$1,467.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,511.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,188.27
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Cash Price |
$1,100.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.00
|
| Rate for Payer: Cigna of CA HMO |
$1,564.80
|
| Rate for Payer: Cigna of CA PPO |
$1,809.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,078.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$978.00
|
| Rate for Payer: Galaxy Health WC |
$2,078.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,200.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,833.75
|
| Rate for Payer: IEHP medi-cal |
$855.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,630.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.00
|
| Rate for Payer: Multiplan Commercial |
$1,833.75
|
| Rate for Payer: Networks By Design Commercial |
$1,589.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,078.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: Riverside University Health MISP |
$978.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,467.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,222.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,222.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,222.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,078.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,078.25
|
|
