|
HC SWALLOWING STUDY W VIDEO
|
Facility
|
IP
|
$1,149.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
909001803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.80 |
| Max. Negotiated Rate |
$976.65 |
| Rate for Payer: Adventist Health Commercial |
$229.80
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.60
|
| Rate for Payer: EPIC Health Plan Senior |
$459.60
|
| Rate for Payer: Galaxy Health WC |
$976.65
|
| Rate for Payer: Global Benefits Group Commercial |
$689.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$766.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.76
|
| Rate for Payer: Multiplan Commercial |
$919.20
|
| Rate for Payer: Networks By Design Commercial |
$746.85
|
| Rate for Payer: Prime Health Services Commercial |
$976.65
|
|
|
HC SWALLOWING STUDY W VIDEO
|
Facility
|
OP
|
$1,149.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
909001803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.21 |
| Max. Negotiated Rate |
$976.65 |
| Rate for Payer: Adventist Health Commercial |
$229.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$753.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$369.06
|
| Rate for Payer: Blue Shield of California Commercial |
$703.19
|
| Rate for Payer: Blue Shield of California EPN |
$464.20
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Cigna of CA HMO |
$735.36
|
| Rate for Payer: Cigna of CA PPO |
$850.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$976.65
|
| Rate for Payer: Global Benefits Group Commercial |
$689.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$87.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$766.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$919.20
|
| Rate for Payer: Networks By Design Commercial |
$746.85
|
| Rate for Payer: Prime Health Services Commercial |
$976.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$689.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$689.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC SWEAT CHLORIDE, IONTOPHORESIS
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
900910257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$124.42 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.42
|
| Rate for Payer: Blue Shield of California Commercial |
$20.74
|
| Rate for Payer: Blue Shield of California EPN |
$13.70
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.65
|
| Rate for Payer: EPIC Health Plan Senior |
$67.89
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.97
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.68
|
| Rate for Payer: Vantage Medical Group Senior |
$67.89
|
|
|
HC SWEAT CHLORIDE, IONTOPHORESIS
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 89230
|
| Hospital Charge Code |
900910257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.36
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC SWEAT CHLORIDE MEASUREMENT
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900910680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$175.10 |
| Rate for Payer: Adventist Health Commercial |
$41.20
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.40
|
| Rate for Payer: EPIC Health Plan Senior |
$82.40
|
| Rate for Payer: Galaxy Health WC |
$175.10
|
| Rate for Payer: Global Benefits Group Commercial |
$123.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$127.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.44
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: Networks By Design Commercial |
$133.90
|
| Rate for Payer: Prime Health Services Commercial |
$175.10
|
|
|
HC SWEAT CHLORIDE MEASUREMENT
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900910680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$48.28 |
| Rate for Payer: Adventist Health Commercial |
$4.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.28
|
| Rate for Payer: Blue Shield of California Commercial |
$14.05
|
| Rate for Payer: Blue Shield of California EPN |
$9.28
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Senior |
$5.00
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
|
|
HC SWIMSUITS
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.76
|
| Rate for Payer: Blue Shield of California Commercial |
$72.32
|
| Rate for Payer: Blue Shield of California EPN |
$47.63
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$49.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC SWIMSUITS
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$40.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.76
|
| Rate for Payer: Blue Shield of California Commercial |
$72.32
|
| Rate for Payer: Blue Shield of California EPN |
$47.63
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.60
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$49.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.30
|
| Rate for Payer: Vantage Medical Group Senior |
$83.30
|
|
|
HC SWIMSUITS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$49.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
|
|
HC SWIMSUITS
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380014
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$68.60
|
| Rate for Payer: Cigna of CA PPO |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$49.00
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.78
|
| Rate for Payer: United Healthcare All Other HMO |
$35.80
|
| Rate for Payer: United Healthcare HMO Rider |
$35.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.09
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
915355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$599.25 |
| Rate for Payer: Adventist Health Commercial |
$289.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$528.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.34
|
| Rate for Payer: Blue Shield of California Commercial |
$520.29
|
| Rate for Payer: Blue Shield of California EPN |
$342.63
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$599.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$599.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$493.50
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.25
|
| Rate for Payer: Vantage Medical Group Senior |
$599.25
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
905355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
IP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
915355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$141.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
|
OP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
905355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$599.25 |
| Rate for Payer: Adventist Health Commercial |
$289.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$528.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.34
|
| Rate for Payer: Blue Shield of California Commercial |
$520.29
|
| Rate for Payer: Blue Shield of California EPN |
$342.63
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$599.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$599.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Senior |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$436.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$493.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$493.50
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.59
|
| Rate for Payer: United Healthcare All Other HMO |
$257.54
|
| Rate for Payer: United Healthcare HMO Rider |
$251.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.25
|
| Rate for Payer: Vantage Medical Group Senior |
$599.25
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
915355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
905355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Adventist Health Commercial |
$166.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.16
|
| Rate for Payer: Blue Shield of California Commercial |
$299.63
|
| Rate for Payer: Blue Shield of California EPN |
$197.32
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
905355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
915355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.44 |
| Max. Negotiated Rate |
$345.10 |
| Rate for Payer: Adventist Health Commercial |
$166.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.16
|
| Rate for Payer: Blue Shield of California Commercial |
$299.63
|
| Rate for Payer: Blue Shield of California EPN |
$197.32
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
915355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
915355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.18
|
| Rate for Payer: Blue Shield of California Commercial |
$383.76
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
905355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.18
|
| Rate for Payer: Blue Shield of California Commercial |
$383.76
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
905355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SYMES ADD MEDIAL OPEN SOCKET
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT L5636
|
| Hospital Charge Code |
915355636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Adventist Health Commercial |
$179.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.69
|
| Rate for Payer: Blue Shield of California Commercial |
$323.24
|
| Rate for Payer: Blue Shield of California EPN |
$212.87
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$372.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$372.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$190.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$306.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$306.60
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC SYMES ADD MEDIAL OPEN SOCKET
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT L5636
|
| Hospital Charge Code |
915355636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
|
HC SYMES ADD MEDIAL OPEN SOCKET
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT L5636
|
| Hospital Charge Code |
905355636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
