|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
915356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.51 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Networks By Design Commercial |
$727.50
|
| Rate for Payer: Adventist Health Commercial |
$596.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,091.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$846.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,166.91
|
| Rate for Payer: Blue Shield of California EPN |
$733.32
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,236.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$653.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$596.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,018.50
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Riverside University Health System MISP |
$582.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.75
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
905356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,166.91
|
| Rate for Payer: Blue Shield of California EPN |
$733.32
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
|
|
HC IT ADDITION FRAME TYPE SOCKET
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT L6690
|
| Hospital Charge Code |
915356690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,166.91
|
| Rate for Payer: Blue Shield of California EPN |
$733.32
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,018.50
|
| Rate for Payer: Cigna of CA PPO |
$1,018.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,018.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$923.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$858.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$546.06
|
| Rate for Payer: United Healthcare All Other HMO |
$531.51
|
| Rate for Payer: United Healthcare HMO Rider |
$520.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.51
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
IP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
905356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,324.00 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Adventist Health Commercial |
$2,324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,319.24
|
| Rate for Payer: Blue Shield of California EPN |
$5,856.48
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,296.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,458.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,378.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,855.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,324.00
|
| Rate for Payer: Multiplan Commercial |
$8,715.00
|
| Rate for Payer: Networks By Design Commercial |
$7,553.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
IP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
915356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,324.00 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Adventist Health Commercial |
$2,324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,319.24
|
| Rate for Payer: Blue Shield of California EPN |
$5,856.48
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,296.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,458.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,378.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,855.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,324.00
|
| Rate for Payer: Multiplan Commercial |
$8,715.00
|
| Rate for Payer: Networks By Design Commercial |
$7,553.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
OP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
915356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,805.55 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Adventist Health Commercial |
$4,764.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,391.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,715.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,759.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9,319.24
|
| Rate for Payer: Blue Shield of California EPN |
$5,856.48
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,296.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,877.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,877.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,458.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,062.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,378.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,487.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,855.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,764.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,134.00
|
| Rate for Payer: Multiplan Commercial |
$8,715.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,877.00
|
|
|
HC IT BLKHD HUM SEC INT LOCK ELBW
|
Facility
|
OP
|
$11,620.00
|
|
|
Service Code
|
CPT L6350
|
| Hospital Charge Code |
905356350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,805.55 |
| Max. Negotiated Rate |
$10,458.00 |
| Rate for Payer: Adventist Health Commercial |
$4,764.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,391.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,715.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,759.35
|
| Rate for Payer: Blue Shield of California Commercial |
$9,319.24
|
| Rate for Payer: Blue Shield of California EPN |
$5,856.48
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Cash Price |
$5,229.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,296.00
|
| Rate for Payer: Cigna of CA HMO |
$8,134.00
|
| Rate for Payer: Cigna of CA PPO |
$8,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,877.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,877.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,648.00
|
| Rate for Payer: Galaxy Health WC |
$9,877.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,458.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,062.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,378.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,487.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,855.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,764.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,134.00
|
| Rate for Payer: Multiplan Commercial |
$8,715.00
|
| Rate for Payer: Networks By Design Commercial |
$5,810.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,877.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,360.99
|
| Rate for Payer: United Healthcare All Other HMO |
$4,244.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4,152.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,805.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,877.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,877.00
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
IP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
915356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,832.20 |
| Max. Negotiated Rate |
$8,244.90 |
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,328.80
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Adventist Health Commercial |
$1,832.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,347.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,617.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,244.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,817.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,404.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,832.20
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
| Rate for Payer: Networks By Design Commercial |
$5,954.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
OP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
915356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.23 |
| Max. Negotiated Rate |
$8,244.90 |
| Rate for Payer: Adventist Health Commercial |
$3,756.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,038.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,870.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,328.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,347.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,617.14
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,328.80
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,786.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,786.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,244.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,738.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,817.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,339.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,404.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,756.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,412.70
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,664.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,496.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,496.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,786.85
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
IP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
905356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,832.20 |
| Max. Negotiated Rate |
$8,244.90 |
| Rate for Payer: Adventist Health Commercial |
$1,832.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,347.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,617.14
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,328.80
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,244.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,817.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,404.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,832.20
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
| Rate for Payer: Networks By Design Commercial |
$5,954.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
|
|
HC IT ENDOSK INCLD TISSUE SHAPING
|
Facility
|
OP
|
$9,161.00
|
|
|
Service Code
|
CPT L6570
|
| Hospital Charge Code |
905356570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.23 |
| Max. Negotiated Rate |
$8,244.90 |
| Rate for Payer: Adventist Health Commercial |
$3,756.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,038.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,870.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,328.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,347.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,617.14
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Cash Price |
$4,122.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,328.80
|
| Rate for Payer: Cigna of CA HMO |
$6,412.70
|
| Rate for Payer: Cigna of CA PPO |
$6,412.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,786.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,786.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,412.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,664.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,664.40
|
| Rate for Payer: Galaxy Health WC |
$7,786.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,496.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,244.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,738.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,817.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,339.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,404.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,756.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,412.70
|
| Rate for Payer: Multiplan Commercial |
$6,870.75
|
| Rate for Payer: Networks By Design Commercial |
$4,580.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,786.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,664.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,496.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,496.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3,346.51
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,000.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,786.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,786.85
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
OP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
915356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,846.00 |
| Max. Negotiated Rate |
$42,002.10 |
| Rate for Payer: Adventist Health Commercial |
$19,134.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,667.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,147.36
|
| Rate for Payer: Blue Shield of California Commercial |
$37,428.54
|
| Rate for Payer: Blue Shield of California EPN |
$23,521.18
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,335.20
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,668.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,002.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,846.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29,634.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,295.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,534.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,134.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,668.30
|
| Rate for Payer: Multiplan Commercial |
$35,001.75
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: Riverside University Health System MISP |
$18,667.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,001.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Senior |
$39,668.65
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
IP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
915356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,333.80 |
| Max. Negotiated Rate |
$42,002.10 |
| Rate for Payer: Adventist Health Commercial |
$9,333.80
|
| Rate for Payer: Blue Shield of California Commercial |
$37,428.54
|
| Rate for Payer: Blue Shield of California EPN |
$23,521.18
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,335.20
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,002.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29,634.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,534.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,333.80
|
| Rate for Payer: Multiplan Commercial |
$35,001.75
|
| Rate for Payer: Networks By Design Commercial |
$30,334.85
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
IP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,333.80 |
| Max. Negotiated Rate |
$42,002.10 |
| Rate for Payer: Adventist Health Commercial |
$9,333.80
|
| Rate for Payer: Blue Shield of California Commercial |
$37,428.54
|
| Rate for Payer: Blue Shield of California EPN |
$23,521.18
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,335.20
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,002.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29,634.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,534.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,333.80
|
| Rate for Payer: Multiplan Commercial |
$35,001.75
|
| Rate for Payer: Networks By Design Commercial |
$30,334.85
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
|
|
HC IT MECH ELBOW MYOELECTRIC CONT
|
Facility
|
OP
|
$46,669.00
|
|
|
Service Code
|
CPT L6975
|
| Hospital Charge Code |
905356975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,846.00 |
| Max. Negotiated Rate |
$42,002.10 |
| Rate for Payer: Adventist Health Commercial |
$19,134.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,667.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,001.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,147.36
|
| Rate for Payer: Blue Shield of California Commercial |
$37,428.54
|
| Rate for Payer: Blue Shield of California EPN |
$23,521.18
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Cash Price |
$21,001.05
|
| Rate for Payer: Central Health Plan Commercial |
$37,335.20
|
| Rate for Payer: Cigna of CA HMO |
$32,668.30
|
| Rate for Payer: Cigna of CA PPO |
$32,668.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,668.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39,668.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32,668.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,667.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,667.60
|
| Rate for Payer: Galaxy Health WC |
$39,668.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,001.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$42,002.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,846.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29,634.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,295.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,534.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,134.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32,668.30
|
| Rate for Payer: Multiplan Commercial |
$35,001.75
|
| Rate for Payer: Networks By Design Commercial |
$23,334.50
|
| Rate for Payer: Prime Health Services Commercial |
$39,668.65
|
| Rate for Payer: Riverside University Health System MISP |
$18,667.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,001.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,001.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,514.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17,048.19
|
| Rate for Payer: United Healthcare HMO Rider |
$16,679.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,284.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,668.65
|
| Rate for Payer: Vantage Medical Group Senior |
$39,668.65
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
OP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
905356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12,160.40 |
| Max. Negotiated Rate |
$33,762.60 |
| Rate for Payer: Adventist Health Commercial |
$15,380.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,632.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,135.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,821.89
|
| Rate for Payer: Blue Shield of California Commercial |
$30,086.23
|
| Rate for Payer: Blue Shield of California EPN |
$18,907.06
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Central Health Plan Commercial |
$30,011.20
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,886.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,886.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,762.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,160.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,821.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,433.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,133.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,380.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,259.80
|
| Rate for Payer: Multiplan Commercial |
$28,135.50
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: Riverside University Health System MISP |
$15,005.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,508.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Senior |
$31,886.90
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
IP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
915356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,502.80 |
| Max. Negotiated Rate |
$33,762.60 |
| Rate for Payer: Adventist Health Commercial |
$7,502.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30,086.23
|
| Rate for Payer: Blue Shield of California EPN |
$18,907.06
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Central Health Plan Commercial |
$30,011.20
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,762.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,821.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,133.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,502.80
|
| Rate for Payer: Multiplan Commercial |
$28,135.50
|
| Rate for Payer: Networks By Design Commercial |
$24,384.10
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
OP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
915356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12,160.40 |
| Max. Negotiated Rate |
$33,762.60 |
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Adventist Health Commercial |
$15,380.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20,632.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,135.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21,821.89
|
| Rate for Payer: Blue Shield of California Commercial |
$30,086.23
|
| Rate for Payer: Blue Shield of California EPN |
$18,907.06
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Central Health Plan Commercial |
$30,011.20
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$31,886.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31,886.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,762.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,160.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,821.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,433.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,133.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,380.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26,259.80
|
| Rate for Payer: Multiplan Commercial |
$28,135.50
|
| Rate for Payer: Networks By Design Commercial |
$18,757.00
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: Riverside University Health System MISP |
$15,005.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,508.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31,886.90
|
| Rate for Payer: Vantage Medical Group Senior |
$31,886.90
|
|
|
HC IT MECH ELBOW SWITCH CONTROL
|
Facility
|
IP
|
$37,514.00
|
|
|
Service Code
|
CPT L6970
|
| Hospital Charge Code |
905356970
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,502.80 |
| Max. Negotiated Rate |
$33,762.60 |
| Rate for Payer: Adventist Health Commercial |
$7,502.80
|
| Rate for Payer: Blue Shield of California Commercial |
$30,086.23
|
| Rate for Payer: Blue Shield of California EPN |
$18,907.06
|
| Rate for Payer: Cash Price |
$16,881.30
|
| Rate for Payer: Central Health Plan Commercial |
$30,011.20
|
| Rate for Payer: Cigna of CA HMO |
$26,259.80
|
| Rate for Payer: Cigna of CA PPO |
$26,259.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,259.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,005.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,005.60
|
| Rate for Payer: Galaxy Health WC |
$31,886.90
|
| Rate for Payer: Global Benefits Group Commercial |
$22,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$33,762.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23,821.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,133.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,502.80
|
| Rate for Payer: Multiplan Commercial |
$28,135.50
|
| Rate for Payer: Networks By Design Commercial |
$24,384.10
|
| Rate for Payer: Prime Health Services Commercial |
$31,886.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,079.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,703.86
|
| Rate for Payer: United Healthcare HMO Rider |
$13,407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,285.83
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
OP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
905356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,244.87 |
| Max. Negotiated Rate |
$8,917.20 |
| Rate for Payer: Adventist Health Commercial |
$4,062.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,449.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,431.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,763.48
|
| Rate for Payer: Blue Shield of California Commercial |
$7,946.22
|
| Rate for Payer: Blue Shield of California EPN |
$4,993.63
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,926.40
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,421.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,421.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,935.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,917.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,370.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,291.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,827.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,845.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,935.60
|
| Rate for Payer: Multiplan Commercial |
$7,431.00
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,963.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,944.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,944.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,421.80
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
IP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
905356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,981.60 |
| Max. Negotiated Rate |
$8,917.20 |
| Rate for Payer: Adventist Health Commercial |
$1,981.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,946.22
|
| Rate for Payer: Blue Shield of California EPN |
$4,993.63
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,926.40
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,935.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,917.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,291.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,845.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,981.60
|
| Rate for Payer: Multiplan Commercial |
$7,431.00
|
| Rate for Payer: Networks By Design Commercial |
$6,440.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
IP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
915356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,981.60 |
| Max. Negotiated Rate |
$8,917.20 |
| Rate for Payer: Adventist Health Commercial |
$1,981.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,946.22
|
| Rate for Payer: Blue Shield of California EPN |
$4,993.63
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,926.40
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,935.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,917.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,291.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,845.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,981.60
|
| Rate for Payer: Multiplan Commercial |
$7,431.00
|
| Rate for Payer: Networks By Design Commercial |
$6,440.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
|
|
HC IT PASSIVE RESTORATION
|
Facility
|
OP
|
$9,908.00
|
|
|
Service Code
|
CPT L6360
|
| Hospital Charge Code |
915356360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,244.87 |
| Max. Negotiated Rate |
$8,917.20 |
| Rate for Payer: Adventist Health Commercial |
$4,062.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,449.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,431.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,763.48
|
| Rate for Payer: Blue Shield of California Commercial |
$7,946.22
|
| Rate for Payer: Blue Shield of California EPN |
$4,993.63
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Cash Price |
$4,458.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,926.40
|
| Rate for Payer: Cigna of CA HMO |
$6,935.60
|
| Rate for Payer: Cigna of CA PPO |
$6,935.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,421.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,421.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,935.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,963.20
|
| Rate for Payer: Galaxy Health WC |
$8,421.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,944.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,917.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,370.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,291.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,827.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,845.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,062.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,935.60
|
| Rate for Payer: Multiplan Commercial |
$7,431.00
|
| Rate for Payer: Networks By Design Commercial |
$4,954.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,421.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,963.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,944.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,944.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,718.47
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,541.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,244.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,421.80
|
| Rate for Payer: Vantage Medical Group Senior |
$8,421.80
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
905356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Adventist Health Commercial |
$734.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,944.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,850.69
|
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,937.60
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,331.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,166.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.40
|
| Rate for Payer: Multiplan Commercial |
$2,754.00
|
| Rate for Payer: Networks By Design Commercial |
$2,386.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
|
|
HC IT PASSIVE RESTORATN CAP ONLY
|
Facility
|
IP
|
$3,672.00
|
|
|
Service Code
|
CPT L6370
|
| Hospital Charge Code |
915356370
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$3,304.80 |
| Rate for Payer: Cash Price |
$1,652.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,937.60
|
| Rate for Payer: Cigna of CA HMO |
$2,570.40
|
| Rate for Payer: Cigna of CA PPO |
$2,570.40
|
| Rate for Payer: Adventist Health Commercial |
$734.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,944.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,850.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,468.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,468.80
|
| Rate for Payer: Galaxy Health WC |
$3,121.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,203.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,304.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,331.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,166.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$734.40
|
| Rate for Payer: Multiplan Commercial |
$2,754.00
|
| Rate for Payer: Networks By Design Commercial |
$2,386.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,378.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,341.38
|
| Rate for Payer: United Healthcare HMO Rider |
$1,312.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.58
|
|
