|
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: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Blue Shield of California Commercial |
$121.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$86.35
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| 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 |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
|
|
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 |
$46.16 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| 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 |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.21
|
| Rate for Payer: Blue Shield of California Commercial |
$121.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| 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 Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$46.16
|
| Rate for Payer: InnovAge PACE Commercial |
$78.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| 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 |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| 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
|
OP
|
$157.00
|
|
|
Service Code
|
CPT L6670
|
| Hospital Charge Code |
915356670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.16 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Adventist Health Commercial |
$64.37
|
| 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 |
$117.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.21
|
| Rate for Payer: Blue Shield of California Commercial |
$121.36
|
| Rate for Payer: Blue Shield of California EPN |
$79.13
|
| Rate for Payer: Cash Price |
$86.35
|
| Rate for Payer: Cash Price |
$86.35
|
| 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 Medi-Cal |
$133.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$133.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$46.16
|
| Rate for Payer: InnovAge PACE Commercial |
$78.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$109.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$109.90
|
| 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 |
$58.92
|
| Rate for Payer: United Healthcare All Other HMO |
$57.35
|
| Rate for Payer: United Healthcare HMO Rider |
$56.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$133.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$133.45
|
| Rate for Payer: Vantage Medical Group Senior |
$133.45
|
|
|
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: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Blue Shield of California Commercial |
$608.35
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$432.85
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| 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 |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
|
|
HC UE ADDITION ELBOW LIFT ASSIST
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
915356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.94 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$322.67
|
| 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 |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.21
|
| Rate for Payer: Blue Shield of California Commercial |
$608.35
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| 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 Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$197.94
|
| Rate for Payer: InnovAge PACE Commercial |
$393.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.90
|
| 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 |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| 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
|
OP
|
$787.00
|
|
|
Service Code
|
CPT L6635
|
| Hospital Charge Code |
905356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.94 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$322.67
|
| 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 |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.21
|
| Rate for Payer: Blue Shield of California Commercial |
$608.35
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| 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 Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$197.94
|
| Rate for Payer: InnovAge PACE Commercial |
$393.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.90
|
| 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 |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| 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 |
915356635
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Blue Shield of California Commercial |
$608.35
|
| Rate for Payer: Blue Shield of California EPN |
$396.65
|
| Rate for Payer: Cash Price |
$432.85
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| 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 |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.36
|
| Rate for Payer: United Healthcare All Other HMO |
$287.49
|
| Rate for Payer: United Healthcare HMO Rider |
$281.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.74
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
915356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| 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 |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.62
|
| Rate for Payer: Blue Shield of California Commercial |
$169.29
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cash Price |
$120.45
|
| 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 Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$110.84
|
| Rate for Payer: InnovAge PACE Commercial |
$109.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$135.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.30
|
| 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 |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
905356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$89.79
|
| 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 |
$164.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.62
|
| Rate for Payer: Blue Shield of California Commercial |
$169.29
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$120.45
|
| Rate for Payer: Cash Price |
$120.45
|
| 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 Medi-Cal |
$186.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$186.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$110.84
|
| Rate for Payer: InnovAge PACE Commercial |
$109.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$135.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$153.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$153.30
|
| 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 |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$186.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.15
|
| Rate for Payer: Vantage Medical Group Senior |
$186.15
|
|
|
HC UE ADDITION FLEXIBLE HINGE
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT L6610
|
| Hospital Charge Code |
915356610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$169.29
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$120.45
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$135.56
|
| 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 |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
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: Adventist Health Commercial |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$169.29
|
| Rate for Payer: Blue Shield of California EPN |
$110.38
|
| Rate for Payer: Cash Price |
$120.45
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$135.56
|
| 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 |
$142.35
|
| Rate for Payer: Prime Health Services Commercial |
$186.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.19
|
| Rate for Payer: United Healthcare All Other HMO |
$80.00
|
| Rate for Payer: United Healthcare HMO Rider |
$78.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.72
|
|
|
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: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Blue Shield of California Commercial |
$222.62
|
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$158.40
|
| 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 Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.09
|
| Rate for Payer: United Healthcare All Other HMO |
$105.21
|
| Rate for Payer: United Healthcare HMO Rider |
$102.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.32
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
915356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$118.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.14
|
| Rate for Payer: Blue Shield of California Commercial |
$222.62
|
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$201.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.77
|
| Rate for Payer: InnovAge PACE Commercial |
$144.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$144.00
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Riverside University Health System MISP |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.09
|
| Rate for Payer: United Healthcare All Other HMO |
$105.21
|
| Rate for Payer: United Healthcare HMO Rider |
$102.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
905356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$118.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.14
|
| Rate for Payer: Blue Shield of California Commercial |
$222.62
|
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$201.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.77
|
| Rate for Payer: InnovAge PACE Commercial |
$144.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$144.00
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Riverside University Health System MISP |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.09
|
| Rate for Payer: United Healthcare All Other HMO |
$105.21
|
| Rate for Payer: United Healthcare HMO Rider |
$102.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC UE ADDITION POLYCENTRIC HINGE
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L6600
|
| Hospital Charge Code |
915356600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Blue Shield of California Commercial |
$222.62
|
| Rate for Payer: Blue Shield of California EPN |
$145.15
|
| Rate for Payer: Cash Price |
$158.40
|
| 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 Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.09
|
| Rate for Payer: United Healthcare All Other HMO |
$105.21
|
| Rate for Payer: United Healthcare HMO Rider |
$102.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$94.32
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
915356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$558.39 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Adventist Health Commercial |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$937.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,001.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.96
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,449.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,449.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$710.36
|
| Rate for Payer: InnovAge PACE Commercial |
$852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$784.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,055.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,193.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Riverside University Health System MISP |
$682.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,449.25
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.96
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Cash Price |
$937.75
|
| 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 Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$649.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,055.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.00
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$1,108.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
IP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
915356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$341.00 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Adventist Health Commercial |
$341.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.96
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Cash Price |
$937.75
|
| 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 Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$649.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,055.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.00
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$1,108.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
|
|
HC UE ADDITION SILICONE GEL INSRT
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT L6692
|
| Hospital Charge Code |
905356692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$558.39 |
| Max. Negotiated Rate |
$1,534.50 |
| Rate for Payer: Adventist Health Commercial |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$937.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,278.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,001.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.96
|
| Rate for Payer: Blue Shield of California EPN |
$859.32
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA HMO |
$1,193.50
|
| Rate for Payer: Cigna of CA PPO |
$1,193.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,449.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,449.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$682.00
|
| Rate for Payer: EPIC Health Plan Senior |
$682.00
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$710.36
|
| Rate for Payer: InnovAge PACE Commercial |
$852.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$784.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,055.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$699.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,193.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$852.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Riverside University Health System MISP |
$682.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.89
|
| Rate for Payer: United Healthcare All Other HMO |
$622.84
|
| Rate for Payer: United Healthcare HMO Rider |
$609.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,449.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,449.25
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
915356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.70
|
| Rate for Payer: Blue Shield of California Commercial |
$200.98
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$221.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.50
|
| Rate for Payer: InnovAge PACE Commercial |
$130.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Riverside University Health System MISP |
$104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
915356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Blue Shield of California Commercial |
$200.98
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$143.00
|
| 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 Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.15 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$106.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.70
|
| Rate for Payer: Blue Shield of California Commercial |
$200.98
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Cash Price |
$143.00
|
| Rate for Payer: Central Health Plan Commercial |
$208.00
|
| Rate for Payer: Cigna of CA HMO |
$182.00
|
| Rate for Payer: Cigna of CA PPO |
$182.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$221.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$221.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.50
|
| Rate for Payer: InnovAge PACE Commercial |
$130.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$182.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: Riverside University Health System MISP |
$104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.00
|
| Rate for Payer: Vantage Medical Group Senior |
$221.00
|
|
|
HC UE ADDITION SINGLE PIVOT HINGE
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT L6605
|
| Hospital Charge Code |
905356605
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Blue Shield of California Commercial |
$200.98
|
| Rate for Payer: Blue Shield of California EPN |
$131.04
|
| Rate for Payer: Cash Price |
$143.00
|
| 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 Senior |
$104.00
|
| Rate for Payer: Galaxy Health WC |
$221.00
|
| Rate for Payer: Global Benefits Group Commercial |
$156.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$234.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$173.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$160.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
| Rate for Payer: Networks By Design Commercial |
$169.00
|
| Rate for Payer: Prime Health Services Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.58
|
| Rate for Payer: United Healthcare All Other HMO |
$94.98
|
| Rate for Payer: United Healthcare HMO Rider |
$92.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.15
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
905356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,284.73
|
| Rate for Payer: Blue Shield of California EPN |
$837.65
|
| Rate for Payer: Cash Price |
$914.10
|
| 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 Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.40 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Adventist Health Commercial |
$332.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,284.73
|
| Rate for Payer: Blue Shield of California EPN |
$837.65
|
| Rate for Payer: Cash Price |
$914.10
|
| 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 Senior |
$664.80
|
| Rate for Payer: Galaxy Health WC |
$1,412.70
|
| Rate for Payer: Global Benefits Group Commercial |
$997.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$1,080.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.75
|
| Rate for Payer: United Healthcare All Other HMO |
$607.13
|
| Rate for Payer: United Healthcare HMO Rider |
$594.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$544.30
|
|
