|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
915356686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$544.30 |
| Max. Negotiated Rate |
$1,495.80 |
| Rate for Payer: Adventist Health Commercial |
$681.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,246.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$976.09
|
| 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: 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: Dignity Health Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,412.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,412.70
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$627.44
|
| Rate for Payer: InnovAge PACE Commercial |
$831.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,108.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$693.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,028.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$681.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,163.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,163.40
|
| Rate for Payer: Multiplan Commercial |
$1,246.50
|
| Rate for Payer: Networks By Design Commercial |
$831.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,412.70
|
| Rate for Payer: Riverside University Health System MISP |
$664.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$997.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,412.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,412.70
|
|
|
HC UE ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,662.00
|
|
|
Service Code
|
CPT L6686
|
| Hospital Charge Code |
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
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$90.44
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$90.44
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
915356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.71
|
| Rate for Payer: Blue Shield of California Commercial |
$90.44
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.57
|
| Rate for Payer: InnovAge PACE Commercial |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Riverside University Health System MISP |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT L6632
|
| Hospital Charge Code |
905356632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Adventist Health Commercial |
$47.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.71
|
| Rate for Payer: Blue Shield of California Commercial |
$90.44
|
| Rate for Payer: Blue Shield of California EPN |
$58.97
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$81.90
|
| Rate for Payer: Cigna of CA PPO |
$81.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$99.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$99.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$99.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$105.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.57
|
| Rate for Payer: InnovAge PACE Commercial |
$58.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.90
|
| Rate for Payer: Multiplan Commercial |
$87.75
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
| Rate for Payer: Riverside University Health System MISP |
$46.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$70.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$70.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.91
|
| Rate for Payer: United Healthcare All Other HMO |
$42.74
|
| Rate for Payer: United Healthcare HMO Rider |
$41.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$99.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$99.45
|
| Rate for Payer: Vantage Medical Group Senior |
$99.45
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Blue Shield of California Commercial |
$543.42
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
905356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.23 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.87
|
| Rate for Payer: Blue Shield of California Commercial |
$543.42
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.36
|
| Rate for Payer: InnovAge PACE Commercial |
$351.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health System MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
IP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.60 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$140.60
|
| Rate for Payer: Blue Shield of California Commercial |
$543.42
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.60
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$456.95
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
|
|
HC UE ADD NUDGE CONTROL ELBOW LCK
|
Facility
|
OP
|
$703.00
|
|
|
Service Code
|
CPT L6637
|
| Hospital Charge Code |
915356637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.23 |
| Max. Negotiated Rate |
$632.70 |
| Rate for Payer: Adventist Health Commercial |
$288.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$527.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.87
|
| Rate for Payer: Blue Shield of California Commercial |
$543.42
|
| Rate for Payer: Blue Shield of California EPN |
$354.31
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Cash Price |
$386.65
|
| Rate for Payer: Central Health Plan Commercial |
$562.40
|
| Rate for Payer: Cigna of CA HMO |
$492.10
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$597.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$597.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$597.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.20
|
| Rate for Payer: EPIC Health Plan Senior |
$281.20
|
| Rate for Payer: Galaxy Health WC |
$597.55
|
| Rate for Payer: Global Benefits Group Commercial |
$421.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$632.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.36
|
| Rate for Payer: InnovAge PACE Commercial |
$351.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$492.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$492.10
|
| Rate for Payer: Multiplan Commercial |
$527.25
|
| Rate for Payer: Networks By Design Commercial |
$351.50
|
| Rate for Payer: Prime Health Services Commercial |
$597.55
|
| Rate for Payer: Riverside University Health System MISP |
$281.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.84
|
| Rate for Payer: United Healthcare All Other HMO |
$256.81
|
| Rate for Payer: United Healthcare HMO Rider |
$251.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$597.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$597.55
|
| Rate for Payer: Vantage Medical Group Senior |
$597.55
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,044.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$2,559.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
905356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,289.69 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,312.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,044.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,709.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,969.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,575.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
OP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,289.69 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$1,614.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,165.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,312.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3,044.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,347.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,347.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,709.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,969.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,992.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,756.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,756.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$1,969.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,575.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,362.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,362.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,347.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,347.30
|
|
|
HC UE ADD PROS ELECTRIC LOCK FEAT
|
Facility
|
IP
|
$3,938.00
|
|
|
Service Code
|
CPT L6638
|
| Hospital Charge Code |
915356638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$787.60 |
| Max. Negotiated Rate |
$3,544.20 |
| Rate for Payer: Adventist Health Commercial |
$787.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,044.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,984.75
|
| Rate for Payer: Cash Price |
$2,165.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$2,756.60
|
| Rate for Payer: Cigna of CA PPO |
$2,756.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,575.20
|
| Rate for Payer: Galaxy Health WC |
$3,347.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,362.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,626.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,500.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,437.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.60
|
| Rate for Payer: Multiplan Commercial |
$2,953.50
|
| Rate for Payer: Networks By Design Commercial |
$2,559.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,347.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,477.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,438.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,289.69
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
915356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.74 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Adventist Health Commercial |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$762.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$596.70
|
| Rate for Payer: Blue Shield of California Commercial |
$785.37
|
| Rate for Payer: Blue Shield of California EPN |
$512.06
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$863.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$863.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$482.56
|
| Rate for Payer: InnovAge PACE Commercial |
$508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$711.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$711.20
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: Riverside University Health System MISP |
$406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.60
|
| Rate for Payer: Vantage Medical Group Senior |
$863.60
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
915356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Adventist Health Commercial |
$203.20
|
| Rate for Payer: Blue Shield of California Commercial |
$785.37
|
| Rate for Payer: Blue Shield of California EPN |
$512.06
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.20
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$660.40
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
905356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Adventist Health Commercial |
$203.20
|
| Rate for Payer: Blue Shield of California Commercial |
$785.37
|
| Rate for Payer: Blue Shield of California EPN |
$512.06
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$203.20
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$660.40
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
|
|
HC UE ADD QUICK DISC HOOK ADAPTER
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
CPT L6628
|
| Hospital Charge Code |
905356628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$332.74 |
| Max. Negotiated Rate |
$914.40 |
| Rate for Payer: Adventist Health Commercial |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$762.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$596.70
|
| Rate for Payer: Blue Shield of California Commercial |
$785.37
|
| Rate for Payer: Blue Shield of California EPN |
$512.06
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Cash Price |
$558.80
|
| Rate for Payer: Central Health Plan Commercial |
$812.80
|
| Rate for Payer: Cigna of CA HMO |
$711.20
|
| Rate for Payer: Cigna of CA PPO |
$711.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$863.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$863.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$406.40
|
| Rate for Payer: Galaxy Health WC |
$863.60
|
| Rate for Payer: Global Benefits Group Commercial |
$609.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$914.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$482.56
|
| Rate for Payer: InnovAge PACE Commercial |
$508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$677.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$628.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$711.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$711.20
|
| Rate for Payer: Multiplan Commercial |
$762.00
|
| Rate for Payer: Networks By Design Commercial |
$508.00
|
| Rate for Payer: Prime Health Services Commercial |
$863.60
|
| Rate for Payer: Riverside University Health System MISP |
$406.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$609.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$609.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$381.30
|
| Rate for Payer: United Healthcare All Other HMO |
$371.14
|
| Rate for Payer: United Healthcare HMO Rider |
$363.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$332.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$863.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.60
|
| Rate for Payer: Vantage Medical Group Senior |
$863.60
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
905356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.45 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$194.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$355.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.38
|
| Rate for Payer: Blue Shield of California Commercial |
$366.40
|
| Rate for Payer: Blue Shield of California EPN |
$238.90
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.45
|
| Rate for Payer: InnovAge PACE Commercial |
$237.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Riverside University Health System MISP |
$189.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
OP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
915356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.45 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$194.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$260.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$355.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$278.38
|
| Rate for Payer: Blue Shield of California Commercial |
$366.40
|
| Rate for Payer: Blue Shield of California EPN |
$238.90
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$402.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$402.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$402.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$136.45
|
| Rate for Payer: InnovAge PACE Commercial |
$237.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$331.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$237.00
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: Riverside University Health System MISP |
$189.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$284.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$284.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$402.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$402.90
|
| Rate for Payer: Vantage Medical Group Senior |
$402.90
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
905356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Blue Shield of California Commercial |
$366.40
|
| Rate for Payer: Blue Shield of California EPN |
$238.90
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
|
|
HC UE ADD QUICK DISC LAMINAT COLL
|
Facility
|
IP
|
$474.00
|
|
|
Service Code
|
CPT L6629
|
| Hospital Charge Code |
915356629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$426.60 |
| Rate for Payer: Adventist Health Commercial |
$94.80
|
| Rate for Payer: Blue Shield of California Commercial |
$366.40
|
| Rate for Payer: Blue Shield of California EPN |
$238.90
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Central Health Plan Commercial |
$379.20
|
| Rate for Payer: Cigna of CA HMO |
$331.80
|
| Rate for Payer: Cigna of CA PPO |
$331.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$189.60
|
| Rate for Payer: Galaxy Health WC |
$402.90
|
| Rate for Payer: Global Benefits Group Commercial |
$284.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$426.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$316.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$293.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.80
|
| Rate for Payer: Multiplan Commercial |
$355.50
|
| Rate for Payer: Networks By Design Commercial |
$308.10
|
| Rate for Payer: Prime Health Services Commercial |
$402.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$177.89
|
| Rate for Payer: United Healthcare All Other HMO |
$173.15
|
| Rate for Payer: United Healthcare HMO Rider |
$169.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.24
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
905356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Adventist Health Commercial |
$95.60
|
| Rate for Payer: Blue Shield of California Commercial |
$369.49
|
| Rate for Payer: Blue Shield of California EPN |
$240.91
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.60
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$310.70
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
905356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.54 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Adventist Health Commercial |
$195.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.73
|
| Rate for Payer: Blue Shield of California Commercial |
$369.49
|
| Rate for Payer: Blue Shield of California EPN |
$240.91
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.70
|
| Rate for Payer: InnovAge PACE Commercial |
$239.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.60
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: Riverside University Health System MISP |
$191.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.30
|
| Rate for Payer: Vantage Medical Group Senior |
$406.30
|
|
|
HC UE ADD REMOVABLE INSERT EACH
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT L6691
|
| Hospital Charge Code |
915356691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.54 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Adventist Health Commercial |
$195.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.73
|
| Rate for Payer: Blue Shield of California Commercial |
$369.49
|
| Rate for Payer: Blue Shield of California EPN |
$240.91
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.70
|
| Rate for Payer: InnovAge PACE Commercial |
$239.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$397.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.60
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: Riverside University Health System MISP |
$191.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.30
|
| Rate for Payer: Vantage Medical Group Senior |
$406.30
|
|
