|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
905356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$708.84
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
915356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Blue Shield of California Commercial |
$708.84
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
905356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.62 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.55
|
| Rate for Payer: Blue Shield of California Commercial |
$708.84
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.62
|
| Rate for Payer: InnovAge PACE Commercial |
$458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$641.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health System MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SHOULDER UNIVER JT EACH
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT L6650
|
| Hospital Charge Code |
915356650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.62 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Adventist Health Commercial |
$375.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$504.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$538.55
|
| Rate for Payer: Blue Shield of California Commercial |
$708.84
|
| Rate for Payer: Blue Shield of California EPN |
$462.17
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$641.90
|
| Rate for Payer: Cigna of CA PPO |
$641.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$779.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$779.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: EPIC Health Plan Senior |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.62
|
| Rate for Payer: InnovAge PACE Commercial |
$458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$567.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$375.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$641.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$641.90
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$458.50
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| Rate for Payer: Riverside University Health System MISP |
$366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.15
|
| Rate for Payer: United Healthcare All Other HMO |
$334.98
|
| Rate for Payer: United Healthcare HMO Rider |
$327.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$779.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$779.45
|
| Rate for Payer: Vantage Medical Group Senior |
$779.45
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
915356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.37 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Adventist Health Commercial |
$637.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,167.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$913.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.79
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,322.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,322.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$426.37
|
| Rate for Payer: InnovAge PACE Commercial |
$778.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$963.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$778.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: Riverside University Health System MISP |
$622.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,322.60
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
915356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.20 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Adventist Health Commercial |
$311.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.79
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$963.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$1,011.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
905356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.37 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Adventist Health Commercial |
$637.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,167.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$913.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.79
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,322.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,322.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$426.37
|
| Rate for Payer: InnovAge PACE Commercial |
$778.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$963.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$637.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$778.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: Riverside University Health System MISP |
$622.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$933.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,322.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,322.60
|
|
|
HC UE ADD SPRING ASSIT ROTAT WRST
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT L6623
|
| Hospital Charge Code |
905356623
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.20 |
| Max. Negotiated Rate |
$1,400.40 |
| Rate for Payer: Adventist Health Commercial |
$311.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,202.79
|
| Rate for Payer: Blue Shield of California EPN |
$784.22
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,244.80
|
| Rate for Payer: Cigna of CA HMO |
$1,089.20
|
| Rate for Payer: Cigna of CA PPO |
$1,089.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.40
|
| Rate for Payer: EPIC Health Plan Senior |
$622.40
|
| Rate for Payer: Galaxy Health WC |
$1,322.60
|
| Rate for Payer: Global Benefits Group Commercial |
$933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,400.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$963.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.20
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Networks By Design Commercial |
$1,011.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,322.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.97
|
| Rate for Payer: United Healthcare All Other HMO |
$568.41
|
| Rate for Payer: United Healthcare HMO Rider |
$556.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$509.59
|
|
|
HC UE ADD STNDRD CONTL CABLE EX
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
905356655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: 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 ADD STNDRD CONTL CABLE EX
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
905356655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.09 |
| 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 |
$55.09
|
| 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 |
$60.86
|
| 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 ADD STNDRD CONTL CABLE EX
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
915356655
|
|
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 ADD STNDRD CONTL CABLE EX
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L6655
|
| Hospital Charge Code |
915356655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.09 |
| 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 |
$55.09
|
| 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 |
$60.86
|
| 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 ADD STNLESS STEEL ANY WRIST
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
905356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$148.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$271.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.60
|
| Rate for Payer: Blue Shield of California Commercial |
$279.83
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$307.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$307.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.35
|
| Rate for Payer: InnovAge PACE Commercial |
$181.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$253.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$181.00
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Riverside University Health System MISP |
$144.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$307.70
|
| Rate for Payer: Vantage Medical Group Senior |
$307.70
|
|
|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
915356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.56 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$148.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$199.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$271.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.60
|
| Rate for Payer: Blue Shield of California Commercial |
$279.83
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$307.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$307.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.35
|
| Rate for Payer: InnovAge PACE Commercial |
$181.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$253.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$253.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$181.00
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: Riverside University Health System MISP |
$144.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$307.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$307.70
|
| Rate for Payer: Vantage Medical Group Senior |
$307.70
|
|
|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
915356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Blue Shield of California Commercial |
$279.83
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
|
|
HC UE ADD STNLESS STEEL ANY WRIST
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT L6630
|
| Hospital Charge Code |
905356630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$325.80 |
| Rate for Payer: Adventist Health Commercial |
$72.40
|
| Rate for Payer: Blue Shield of California Commercial |
$279.83
|
| Rate for Payer: Blue Shield of California EPN |
$182.45
|
| Rate for Payer: Cash Price |
$199.10
|
| Rate for Payer: Central Health Plan Commercial |
$289.60
|
| Rate for Payer: Cigna of CA HMO |
$253.40
|
| Rate for Payer: Cigna of CA PPO |
$253.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.80
|
| Rate for Payer: EPIC Health Plan Senior |
$144.80
|
| Rate for Payer: Galaxy Health WC |
$307.70
|
| Rate for Payer: Global Benefits Group Commercial |
$217.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$325.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$241.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$224.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.40
|
| Rate for Payer: Multiplan Commercial |
$271.50
|
| Rate for Payer: Networks By Design Commercial |
$235.30
|
| Rate for Payer: Prime Health Services Commercial |
$307.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.86
|
| Rate for Payer: United Healthcare All Other HMO |
$132.24
|
| Rate for Payer: United Healthcare HMO Rider |
$129.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.56
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
915356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$31.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: Blue Shield of California Commercial |
$59.52
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.65
|
| Rate for Payer: InnovAge PACE Commercial |
$38.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Riverside University Health System MISP |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Blue Shield of California Commercial |
$59.52
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
905356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$31.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.22
|
| Rate for Payer: Blue Shield of California Commercial |
$59.52
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.65
|
| Rate for Payer: InnovAge PACE Commercial |
$38.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$38.50
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Riverside University Health System MISP |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC UE ADD TEFLON CABLE LINING
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT L6665
|
| Hospital Charge Code |
915356665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Blue Shield of California Commercial |
$59.52
|
| Rate for Payer: Blue Shield of California EPN |
$38.81
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$53.90
|
| Rate for Payer: Cigna of CA PPO |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other HMO |
$28.13
|
| Rate for Payer: United Healthcare HMO Rider |
$27.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.22
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
915356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.77
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.47 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.78
|
| Rate for Payer: Blue Shield of California Commercial |
$378.77
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$321.35
|
| Rate for Payer: InnovAge PACE Commercial |
$245.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Riverside University Health System MISP |
$196.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
IP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
905356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$98.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.77
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$318.50
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
|
|
HC UE TRIPLE CONTROL HARNESS
|
Facility
|
OP
|
$490.00
|
|
|
Service Code
|
CPT L6677
|
| Hospital Charge Code |
915356677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.47 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Adventist Health Commercial |
$200.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$269.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$367.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$287.78
|
| Rate for Payer: Blue Shield of California Commercial |
$378.77
|
| Rate for Payer: Blue Shield of California EPN |
$246.96
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Cash Price |
$269.50
|
| Rate for Payer: Central Health Plan Commercial |
$392.00
|
| Rate for Payer: Cigna of CA HMO |
$343.00
|
| Rate for Payer: Cigna of CA PPO |
$343.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$416.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$196.00
|
| Rate for Payer: Galaxy Health WC |
$416.50
|
| Rate for Payer: Global Benefits Group Commercial |
$294.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$441.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$321.35
|
| Rate for Payer: InnovAge PACE Commercial |
$245.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$326.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$354.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$343.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$343.00
|
| Rate for Payer: Multiplan Commercial |
$367.50
|
| Rate for Payer: Networks By Design Commercial |
$245.00
|
| Rate for Payer: Prime Health Services Commercial |
$416.50
|
| Rate for Payer: Riverside University Health System MISP |
$196.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.90
|
| Rate for Payer: United Healthcare All Other HMO |
$179.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$416.50
|
| Rate for Payer: Vantage Medical Group Senior |
$416.50
|
|
|
HC UGI AIR CONTRAST WITH SMB
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 74249
|
| Hospital Charge Code |
909001792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$1,153.80 |
| Rate for Payer: Adventist Health Commercial |
$256.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,089.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$705.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$961.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$620.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$752.92
|
| Rate for Payer: Blue Shield of California Commercial |
$778.17
|
| Rate for Payer: Blue Shield of California EPN |
$508.95
|
| Rate for Payer: Cash Price |
$705.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Cigna of CA HMO |
$820.48
|
| Rate for Payer: Cigna of CA PPO |
$948.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,089.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,089.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,089.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Senior |
$512.80
|
| Rate for Payer: Galaxy Health WC |
$1,089.70
|
| Rate for Payer: Global Benefits Group Commercial |
$769.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,153.80
|
| Rate for Payer: InnovAge PACE Commercial |
$641.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$855.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$793.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.40
|
| Rate for Payer: Multiplan Commercial |
$961.50
|
| Rate for Payer: Networks By Design Commercial |
$833.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,089.70
|
| Rate for Payer: Riverside University Health System MISP |
$512.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$769.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$769.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.00
|
| Rate for Payer: United Healthcare All Other HMO |
$641.00
|
| Rate for Payer: United Healthcare HMO Rider |
$641.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,089.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,089.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,089.70
|
|
