|
HC ELEC KNEE-SHIN SWING/STANCE
|
Facility
|
OP
|
$47,249.00
|
|
|
Service Code
|
CPT L5856
|
| Hospital Charge Code |
905355856
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15,474.05 |
| Max. Negotiated Rate |
$42,524.10 |
| Rate for Payer: Adventist Health Commercial |
$19,372.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,986.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,436.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,749.34
|
| Rate for Payer: Blue Shield of California Commercial |
$36,523.48
|
| Rate for Payer: Blue Shield of California EPN |
$23,813.50
|
| Rate for Payer: Cash Price |
$21,262.05
|
| Rate for Payer: Cash Price |
$21,262.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,799.20
|
| Rate for Payer: Cigna of CA HMO |
$33,074.30
|
| Rate for Payer: Cigna of CA PPO |
$33,074.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,161.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,161.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,899.60
|
| Rate for Payer: Galaxy Health WC |
$40,161.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,349.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,524.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,005.87
|
| Rate for Payer: InnovAge PACE Commercial |
$23,624.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,515.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,727.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,247.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,372.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,074.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,074.30
|
| Rate for Payer: Multiplan Commercial |
$35,436.75
|
| Rate for Payer: Networks By Design Commercial |
$23,624.50
|
| Rate for Payer: Prime Health Services Commercial |
$40,161.65
|
| Rate for Payer: Riverside University Health System MISP |
$18,899.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,349.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,349.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,732.55
|
| Rate for Payer: United Healthcare All Other HMO |
$17,260.06
|
| Rate for Payer: United Healthcare HMO Rider |
$16,886.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,474.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,161.65
|
| Rate for Payer: Vantage Medical Group Senior |
$40,161.65
|
|
|
HC ELEC KNEE-SHIN SWING/STANCE
|
Facility
|
OP
|
$47,249.00
|
|
|
Service Code
|
CPT L5856
|
| Hospital Charge Code |
915355856
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15,474.05 |
| Max. Negotiated Rate |
$42,524.10 |
| Rate for Payer: Adventist Health Commercial |
$19,372.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,986.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,436.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,749.34
|
| Rate for Payer: Blue Shield of California Commercial |
$36,523.48
|
| Rate for Payer: Blue Shield of California EPN |
$23,813.50
|
| Rate for Payer: Cash Price |
$21,262.05
|
| Rate for Payer: Cash Price |
$21,262.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,799.20
|
| Rate for Payer: Cigna of CA HMO |
$33,074.30
|
| Rate for Payer: Cigna of CA PPO |
$33,074.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,161.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,161.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,899.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,899.60
|
| Rate for Payer: Galaxy Health WC |
$40,161.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,349.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,524.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26,005.87
|
| Rate for Payer: InnovAge PACE Commercial |
$23,624.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,515.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28,727.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,247.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,372.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,074.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,074.30
|
| Rate for Payer: Multiplan Commercial |
$35,436.75
|
| Rate for Payer: Networks By Design Commercial |
$23,624.50
|
| Rate for Payer: Prime Health Services Commercial |
$40,161.65
|
| Rate for Payer: Riverside University Health System MISP |
$18,899.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,349.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,349.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,732.55
|
| Rate for Payer: United Healthcare All Other HMO |
$17,260.06
|
| Rate for Payer: United Healthcare HMO Rider |
$16,886.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,474.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,161.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,161.65
|
| Rate for Payer: Vantage Medical Group Senior |
$40,161.65
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
OP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
905357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,095.25 |
| Max. Negotiated Rate |
$21,003.30 |
| Rate for Payer: Adventist Health Commercial |
$9,568.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,835.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,502.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,705.82
|
| Rate for Payer: Blue Shield of California Commercial |
$18,039.50
|
| Rate for Payer: Blue Shield of California EPN |
$11,761.85
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Central Health Plan Commercial |
$18,669.60
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,836.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,836.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,003.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,095.25
|
| Rate for Payer: InnovAge PACE Commercial |
$11,668.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,733.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,568.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,335.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,335.90
|
| Rate for Payer: Multiplan Commercial |
$17,502.75
|
| Rate for Payer: Networks By Design Commercial |
$11,668.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: Riverside University Health System MISP |
$9,334.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,002.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,002.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Senior |
$19,836.45
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
IP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
915357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,667.40 |
| Max. Negotiated Rate |
$21,003.30 |
| Rate for Payer: Adventist Health Commercial |
$4,667.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18,039.50
|
| Rate for Payer: Blue Shield of California EPN |
$11,761.85
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Central Health Plan Commercial |
$18,669.60
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,003.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,891.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,667.40
|
| Rate for Payer: Multiplan Commercial |
$17,502.75
|
| Rate for Payer: Networks By Design Commercial |
$15,169.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
OP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
915357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,095.25 |
| Max. Negotiated Rate |
$21,003.30 |
| Rate for Payer: Adventist Health Commercial |
$9,568.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,835.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,502.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,705.82
|
| Rate for Payer: Blue Shield of California Commercial |
$18,039.50
|
| Rate for Payer: Blue Shield of California EPN |
$11,761.85
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Central Health Plan Commercial |
$18,669.60
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,836.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19,836.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,003.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,095.25
|
| Rate for Payer: InnovAge PACE Commercial |
$11,668.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,733.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,568.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,335.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,335.90
|
| Rate for Payer: Multiplan Commercial |
$17,502.75
|
| Rate for Payer: Networks By Design Commercial |
$11,668.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: Riverside University Health System MISP |
$9,334.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,002.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,002.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,836.45
|
| Rate for Payer: Vantage Medical Group Senior |
$19,836.45
|
|
|
HC ELECT ELBOW ADOLESC MYOELECTRC
|
Facility
|
IP
|
$23,337.00
|
|
|
Service Code
|
CPT L7190
|
| Hospital Charge Code |
905357190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,667.40 |
| Max. Negotiated Rate |
$21,003.30 |
| Rate for Payer: Adventist Health Commercial |
$4,667.40
|
| Rate for Payer: Blue Shield of California Commercial |
$18,039.50
|
| Rate for Payer: Blue Shield of California EPN |
$11,761.85
|
| Rate for Payer: Cash Price |
$10,501.65
|
| Rate for Payer: Central Health Plan Commercial |
$18,669.60
|
| Rate for Payer: Cigna of CA HMO |
$16,335.90
|
| Rate for Payer: Cigna of CA PPO |
$16,335.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,334.80
|
| Rate for Payer: EPIC Health Plan Senior |
$9,334.80
|
| Rate for Payer: Galaxy Health WC |
$19,836.45
|
| Rate for Payer: Global Benefits Group Commercial |
$14,002.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,003.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,565.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,891.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,445.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,667.40
|
| Rate for Payer: Multiplan Commercial |
$17,502.75
|
| Rate for Payer: Networks By Design Commercial |
$15,169.05
|
| Rate for Payer: Prime Health Services Commercial |
$19,836.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,758.38
|
| Rate for Payer: United Healthcare All Other HMO |
$8,525.01
|
| Rate for Payer: United Healthcare HMO Rider |
$8,340.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,642.87
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
OP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
915357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,635.40 |
| Max. Negotiated Rate |
$15,671.70 |
| Rate for Payer: Adventist Health Commercial |
$7,139.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,577.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,059.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,226.65
|
| Rate for Payer: Blue Shield of California Commercial |
$13,460.25
|
| Rate for Payer: Blue Shield of California EPN |
$8,776.15
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,930.40
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,801.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,801.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,671.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,635.40
|
| Rate for Payer: InnovAge PACE Commercial |
$8,706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,120.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,139.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,189.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,189.10
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
| Rate for Payer: Networks By Design Commercial |
$8,706.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: Riverside University Health System MISP |
$6,965.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,447.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,447.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14,801.05
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
IP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
915357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,482.60 |
| Max. Negotiated Rate |
$15,671.70 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13,460.25
|
| Rate for Payer: Blue Shield of California EPN |
$8,776.15
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,930.40
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,671.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,634.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,482.60
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
| Rate for Payer: Networks By Design Commercial |
$11,318.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
IP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
905357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,482.60 |
| Max. Negotiated Rate |
$15,671.70 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13,460.25
|
| Rate for Payer: Blue Shield of California EPN |
$8,776.15
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,930.40
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,671.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,634.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,482.60
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
| Rate for Payer: Networks By Design Commercial |
$11,318.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
|
|
HC ELECT ELBOW ADOLESC SWTCH CONT
|
Facility
|
OP
|
$17,413.00
|
|
|
Service Code
|
CPT L7185
|
| Hospital Charge Code |
905357185
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,635.40 |
| Max. Negotiated Rate |
$15,671.70 |
| Rate for Payer: Adventist Health Commercial |
$7,139.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,577.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,059.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,226.65
|
| Rate for Payer: Blue Shield of California Commercial |
$13,460.25
|
| Rate for Payer: Blue Shield of California EPN |
$8,776.15
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,930.40
|
| Rate for Payer: Cigna of CA HMO |
$12,189.10
|
| Rate for Payer: Cigna of CA PPO |
$12,189.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,801.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,801.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,965.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,965.20
|
| Rate for Payer: Galaxy Health WC |
$14,801.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10,447.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,671.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,635.40
|
| Rate for Payer: InnovAge PACE Commercial |
$8,706.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,614.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,120.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,778.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,139.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,189.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,189.10
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
| Rate for Payer: Networks By Design Commercial |
$8,706.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,801.05
|
| Rate for Payer: Riverside University Health System MISP |
$6,965.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,447.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,447.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,535.10
|
| Rate for Payer: United Healthcare All Other HMO |
$6,360.97
|
| Rate for Payer: United Healthcare HMO Rider |
$6,223.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,702.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,801.05
|
| Rate for Payer: Vantage Medical Group Senior |
$14,801.05
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
IP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
905357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,562.40 |
| Max. Negotiated Rate |
$25,030.80 |
| Rate for Payer: Adventist Health Commercial |
$5,562.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21,498.68
|
| Rate for Payer: Blue Shield of California EPN |
$14,017.25
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,249.60
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,030.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,596.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,562.40
|
| Rate for Payer: Multiplan Commercial |
$20,859.00
|
| Rate for Payer: Networks By Design Commercial |
$18,077.80
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
OP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
915357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,094.73 |
| Max. Negotiated Rate |
$25,030.80 |
| Rate for Payer: Adventist Health Commercial |
$11,402.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,296.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,859.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,333.99
|
| Rate for Payer: Blue Shield of California Commercial |
$21,498.68
|
| Rate for Payer: Blue Shield of California EPN |
$14,017.25
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,249.60
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,640.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,640.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,030.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,094.73
|
| Rate for Payer: InnovAge PACE Commercial |
$13,906.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,941.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,402.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,468.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,468.40
|
| Rate for Payer: Multiplan Commercial |
$20,859.00
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: Riverside University Health System MISP |
$11,124.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,687.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,687.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Senior |
$23,640.20
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
IP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
915357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,562.40 |
| Max. Negotiated Rate |
$25,030.80 |
| Rate for Payer: Adventist Health Commercial |
$5,562.40
|
| Rate for Payer: Blue Shield of California Commercial |
$21,498.68
|
| Rate for Payer: Blue Shield of California EPN |
$14,017.25
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,249.60
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,030.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,596.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,562.40
|
| Rate for Payer: Multiplan Commercial |
$20,859.00
|
| Rate for Payer: Networks By Design Commercial |
$18,077.80
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
|
|
HC ELECT ELBOW CHILD MYOELECTRIC
|
Facility
|
OP
|
$27,812.00
|
|
|
Service Code
|
CPT L7191
|
| Hospital Charge Code |
905357191
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8,094.73 |
| Max. Negotiated Rate |
$25,030.80 |
| Rate for Payer: Adventist Health Commercial |
$11,402.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,296.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,859.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,333.99
|
| Rate for Payer: Blue Shield of California Commercial |
$21,498.68
|
| Rate for Payer: Blue Shield of California EPN |
$14,017.25
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Cash Price |
$12,515.40
|
| Rate for Payer: Central Health Plan Commercial |
$22,249.60
|
| Rate for Payer: Cigna of CA HMO |
$19,468.40
|
| Rate for Payer: Cigna of CA PPO |
$19,468.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,640.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,640.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,124.80
|
| Rate for Payer: Galaxy Health WC |
$23,640.20
|
| Rate for Payer: Global Benefits Group Commercial |
$16,687.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,030.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,094.73
|
| Rate for Payer: InnovAge PACE Commercial |
$13,906.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18,550.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,941.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,215.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,402.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,468.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,468.40
|
| Rate for Payer: Multiplan Commercial |
$20,859.00
|
| Rate for Payer: Networks By Design Commercial |
$13,906.00
|
| Rate for Payer: Prime Health Services Commercial |
$23,640.20
|
| Rate for Payer: Riverside University Health System MISP |
$11,124.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,687.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16,687.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,437.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10,159.72
|
| Rate for Payer: United Healthcare HMO Rider |
$9,940.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,108.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,640.20
|
| Rate for Payer: Vantage Medical Group Senior |
$23,640.20
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
OP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
905357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,531.70 |
| Max. Negotiated Rate |
$23,886.00 |
| Rate for Payer: Adventist Health Commercial |
$10,881.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,597.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,905.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,586.94
|
| Rate for Payer: Blue Shield of California Commercial |
$20,515.42
|
| Rate for Payer: Blue Shield of California EPN |
$13,376.16
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,232.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,559.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,559.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,886.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,531.70
|
| Rate for Payer: InnovAge PACE Commercial |
$13,270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,215.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,881.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,578.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,578.00
|
| Rate for Payer: Multiplan Commercial |
$19,905.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,616.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,559.00
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
IP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
905357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,308.00 |
| Max. Negotiated Rate |
$23,886.00 |
| Rate for Payer: Adventist Health Commercial |
$5,308.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20,515.42
|
| Rate for Payer: Blue Shield of California EPN |
$13,376.16
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,232.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,886.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,111.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,308.00
|
| Rate for Payer: Multiplan Commercial |
$19,905.00
|
| Rate for Payer: Networks By Design Commercial |
$17,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
IP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
915357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,308.00 |
| Max. Negotiated Rate |
$23,886.00 |
| Rate for Payer: Adventist Health Commercial |
$5,308.00
|
| Rate for Payer: Blue Shield of California Commercial |
$20,515.42
|
| Rate for Payer: Blue Shield of California EPN |
$13,376.16
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,232.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,886.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,111.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,308.00
|
| Rate for Payer: Multiplan Commercial |
$19,905.00
|
| Rate for Payer: Networks By Design Commercial |
$17,251.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
|
|
HC ELECT ELBOW CHILD SWITCH CONTR
|
Facility
|
OP
|
$26,540.00
|
|
|
Service Code
|
CPT L7186
|
| Hospital Charge Code |
915357186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,531.70 |
| Max. Negotiated Rate |
$23,886.00 |
| Rate for Payer: Adventist Health Commercial |
$10,881.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,597.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,905.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,586.94
|
| Rate for Payer: Blue Shield of California Commercial |
$20,515.42
|
| Rate for Payer: Blue Shield of California EPN |
$13,376.16
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Cash Price |
$11,943.00
|
| Rate for Payer: Central Health Plan Commercial |
$21,232.00
|
| Rate for Payer: Cigna of CA HMO |
$18,578.00
|
| Rate for Payer: Cigna of CA PPO |
$18,578.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,559.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,559.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,616.00
|
| Rate for Payer: Galaxy Health WC |
$22,559.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,924.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,886.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,531.70
|
| Rate for Payer: InnovAge PACE Commercial |
$13,270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,702.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,215.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,428.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,881.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,578.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,578.00
|
| Rate for Payer: Multiplan Commercial |
$19,905.00
|
| Rate for Payer: Networks By Design Commercial |
$13,270.00
|
| Rate for Payer: Prime Health Services Commercial |
$22,559.00
|
| Rate for Payer: Riverside University Health System MISP |
$10,616.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,924.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,960.46
|
| Rate for Payer: United Healthcare All Other HMO |
$9,695.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9,485.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,691.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,559.00
|
| Rate for Payer: Vantage Medical Group Senior |
$22,559.00
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
IP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,403.80 |
| Max. Negotiated Rate |
$15,317.10 |
| Rate for Payer: Adventist Health Commercial |
$3,403.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,155.69
|
| Rate for Payer: Blue Shield of California EPN |
$8,577.58
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,615.20
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,317.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,403.80
|
| Rate for Payer: Multiplan Commercial |
$12,764.25
|
| Rate for Payer: Networks By Design Commercial |
$11,062.35
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
IP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
915357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,403.80 |
| Max. Negotiated Rate |
$15,317.10 |
| Rate for Payer: Adventist Health Commercial |
$3,403.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,155.69
|
| Rate for Payer: Blue Shield of California EPN |
$8,577.58
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,615.20
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,317.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,403.80
|
| Rate for Payer: Multiplan Commercial |
$12,764.25
|
| Rate for Payer: Networks By Design Commercial |
$11,062.35
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
OP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
905357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,424.70 |
| Max. Negotiated Rate |
$15,317.10 |
| Rate for Payer: Adventist Health Commercial |
$6,977.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,360.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,995.26
|
| Rate for Payer: Blue Shield of California Commercial |
$13,155.69
|
| Rate for Payer: Blue Shield of California EPN |
$8,577.58
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,615.20
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,466.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,466.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,317.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,424.70
|
| Rate for Payer: InnovAge PACE Commercial |
$8,509.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,887.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,977.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,913.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,913.30
|
| Rate for Payer: Multiplan Commercial |
$12,764.25
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: Riverside University Health System MISP |
$6,807.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,466.15
|
|
|
HC ELECT ELBOW HOSMER SWITCH CONT
|
Facility
|
OP
|
$17,019.00
|
|
|
Service Code
|
CPT L7170
|
| Hospital Charge Code |
915357170
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,424.70 |
| Max. Negotiated Rate |
$15,317.10 |
| Rate for Payer: Adventist Health Commercial |
$6,977.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,360.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,764.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,995.26
|
| Rate for Payer: Blue Shield of California Commercial |
$13,155.69
|
| Rate for Payer: Blue Shield of California EPN |
$8,577.58
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Cash Price |
$7,658.55
|
| Rate for Payer: Central Health Plan Commercial |
$13,615.20
|
| Rate for Payer: Cigna of CA HMO |
$11,913.30
|
| Rate for Payer: Cigna of CA PPO |
$11,913.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,466.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,466.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,807.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,807.60
|
| Rate for Payer: Galaxy Health WC |
$14,466.15
|
| Rate for Payer: Global Benefits Group Commercial |
$10,211.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,317.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,424.70
|
| Rate for Payer: InnovAge PACE Commercial |
$8,509.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,351.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,887.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,534.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,977.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,913.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,913.30
|
| Rate for Payer: Multiplan Commercial |
$12,764.25
|
| Rate for Payer: Networks By Design Commercial |
$8,509.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,466.15
|
| Rate for Payer: Riverside University Health System MISP |
$6,807.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,211.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,211.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,387.23
|
| Rate for Payer: United Healthcare All Other HMO |
$6,217.04
|
| Rate for Payer: United Healthcare HMO Rider |
$6,082.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,573.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,466.15
|
| Rate for Payer: Vantage Medical Group Senior |
$14,466.15
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
OP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
915357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28,053.20 |
| Max. Negotiated Rate |
$102,596.40 |
| Rate for Payer: Adventist Health Commercial |
$46,738.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,697.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85,497.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,949.85
|
| Rate for Payer: Blue Shield of California Commercial |
$88,118.91
|
| Rate for Payer: Blue Shield of California EPN |
$57,453.98
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Central Health Plan Commercial |
$91,196.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$96,896.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$102,596.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28,053.20
|
| Rate for Payer: InnovAge PACE Commercial |
$56,998.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,989.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46,738.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,797.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,797.20
|
| Rate for Payer: Multiplan Commercial |
$85,497.00
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: Riverside University Health System MISP |
$45,598.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Senior |
$96,896.60
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
OP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28,053.20 |
| Max. Negotiated Rate |
$102,596.40 |
| Rate for Payer: Adventist Health Commercial |
$46,738.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,697.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85,497.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,949.85
|
| Rate for Payer: Blue Shield of California Commercial |
$88,118.91
|
| Rate for Payer: Blue Shield of California EPN |
$57,453.98
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Central Health Plan Commercial |
$91,196.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$96,896.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96,896.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$102,596.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28,053.20
|
| Rate for Payer: InnovAge PACE Commercial |
$56,998.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,989.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46,738.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79,797.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79,797.20
|
| Rate for Payer: Multiplan Commercial |
$85,497.00
|
| Rate for Payer: Networks By Design Commercial |
$56,998.00
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: Riverside University Health System MISP |
$45,598.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68,397.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68,397.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96,896.60
|
| Rate for Payer: Vantage Medical Group Senior |
$96,896.60
|
|
|
HC ELECT ELBOW UTAH MYOELECT CONT
|
Facility
|
IP
|
$113,996.00
|
|
|
Service Code
|
CPT L7180
|
| Hospital Charge Code |
905357180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22,799.20 |
| Max. Negotiated Rate |
$102,596.40 |
| Rate for Payer: Adventist Health Commercial |
$22,799.20
|
| Rate for Payer: Blue Shield of California Commercial |
$88,118.91
|
| Rate for Payer: Blue Shield of California EPN |
$57,453.98
|
| Rate for Payer: Cash Price |
$51,298.20
|
| Rate for Payer: Central Health Plan Commercial |
$91,196.80
|
| Rate for Payer: Cigna of CA HMO |
$79,797.20
|
| Rate for Payer: Cigna of CA PPO |
$79,797.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45,598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$45,598.40
|
| Rate for Payer: Galaxy Health WC |
$96,896.60
|
| Rate for Payer: Global Benefits Group Commercial |
$68,397.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$102,596.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76,035.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43,432.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70,563.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,799.20
|
| Rate for Payer: Multiplan Commercial |
$85,497.00
|
| Rate for Payer: Networks By Design Commercial |
$74,097.40
|
| Rate for Payer: Prime Health Services Commercial |
$96,896.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$42,782.70
|
| Rate for Payer: United Healthcare All Other HMO |
$41,642.74
|
| Rate for Payer: United Healthcare HMO Rider |
$40,742.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37,333.69
|
|
