|
HC SYMES ADD SKT INSRT-PELITE LIN
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT L5654
|
| Hospital Charge Code |
915355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$556.75 |
| Rate for Payer: Adventist Health Commercial |
$268.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$360.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.38
|
| Rate for Payer: Blue Shield of California Commercial |
$483.39
|
| Rate for Payer: Blue Shield of California EPN |
$318.33
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$556.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$556.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.50
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Networks By Design Commercial |
$327.50
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$556.75
|
| Rate for Payer: Vantage Medical Group Senior |
$556.75
|
|
|
HC SYMES ADD SKT INSRT-PELITE LIN
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT L5654
|
| Hospital Charge Code |
905355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Networks By Design Commercial |
$327.50
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
|
|
HC SYMES ADD SKT INSRT-PELITE LIN
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT L5654
|
| Hospital Charge Code |
915355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Networks By Design Commercial |
$327.50
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
|
|
HC SYMES ADD SKT INSRT-PELITE LIN
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT L5654
|
| Hospital Charge Code |
905355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$556.75 |
| Rate for Payer: Adventist Health Commercial |
$268.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$360.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.38
|
| Rate for Payer: Blue Shield of California Commercial |
$483.39
|
| Rate for Payer: Blue Shield of California EPN |
$318.33
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$556.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$556.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.50
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Networks By Design Commercial |
$327.50
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$556.75
|
| Rate for Payer: Vantage Medical Group Senior |
$556.75
|
|
|
HC SYMES ADD SKT INST MULTI-DUROM
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
915355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.08 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Adventist Health Commercial |
$529.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$969.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$748.33
|
| Rate for Payer: Blue Shield of California Commercial |
$953.50
|
| Rate for Payer: Blue Shield of California EPN |
$627.91
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,098.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$516.80
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$579.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.40
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: Networks By Design Commercial |
$646.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$775.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$775.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,098.20
|
|
|
HC SYMES ADD SKT INST MULTI-DUROM
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
915355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$516.80
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.08
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: Networks By Design Commercial |
$646.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
|
|
HC SYMES ADD SKT INST MULTI-DUROM
|
Facility
|
IP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
905355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$516.80
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.08
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: Networks By Design Commercial |
$646.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
|
|
HC SYMES ADD SKT INST MULTI-DUROM
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
905355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.08 |
| Max. Negotiated Rate |
$1,098.20 |
| Rate for Payer: Adventist Health Commercial |
$529.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$969.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$748.33
|
| Rate for Payer: Blue Shield of California Commercial |
$953.50
|
| Rate for Payer: Blue Shield of California EPN |
$627.91
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,098.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$516.80
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$579.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.40
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: Networks By Design Commercial |
$646.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$775.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$775.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,098.20
|
|
|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
|
IP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
905355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,612.00
|
| Rate for Payer: Galaxy Health WC |
$3,425.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,535.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$967.20
|
| Rate for Payer: Multiplan Commercial |
$3,224.00
|
| Rate for Payer: Networks By Design Commercial |
$2,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
|
|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
|
IP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
915355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,612.00
|
| Rate for Payer: Galaxy Health WC |
$3,425.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,418.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,535.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$967.20
|
| Rate for Payer: Multiplan Commercial |
$3,224.00
|
| Rate for Payer: Networks By Design Commercial |
$2,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
|
|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
|
OP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
905355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$967.20 |
| Max. Negotiated Rate |
$3,425.50 |
| Rate for Payer: Adventist Health Commercial |
$1,652.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,425.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,216.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,022.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,334.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,974.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,958.58
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,425.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,425.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,612.00
|
| Rate for Payer: Galaxy Health WC |
$3,425.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,418.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,594.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,934.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$967.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,821.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,821.00
|
| Rate for Payer: Multiplan Commercial |
$3,224.00
|
| Rate for Payer: Networks By Design Commercial |
$2,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,418.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,418.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,425.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,425.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,425.50
|
|
|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
|
OP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
915355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$967.20 |
| Max. Negotiated Rate |
$3,425.50 |
| Rate for Payer: Adventist Health Commercial |
$1,652.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,425.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,216.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,022.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,334.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,974.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,958.58
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,425.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,425.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,612.00
|
| Rate for Payer: Galaxy Health WC |
$3,425.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,418.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,594.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,934.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$967.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,821.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,821.00
|
| Rate for Payer: Multiplan Commercial |
$3,224.00
|
| Rate for Payer: Networks By Design Commercial |
$2,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,418.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,418.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,425.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,425.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,425.50
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
OP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
905355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,390.40 |
| Max. Negotiated Rate |
$8,466.00 |
| Rate for Payer: Adventist Health Commercial |
$4,083.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,478.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,470.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,768.83
|
| Rate for Payer: Blue Shield of California Commercial |
$7,350.48
|
| Rate for Payer: Blue Shield of California EPN |
$4,840.56
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,466.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,716.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,390.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,972.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,972.00
|
| Rate for Payer: Multiplan Commercial |
$7,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,976.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,976.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,466.00
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
IP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
905355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,992.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,992.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,794.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,390.40
|
| Rate for Payer: Multiplan Commercial |
$7,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
IP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
915355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,992.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,992.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,794.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,390.40
|
| Rate for Payer: Multiplan Commercial |
$7,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
|
OP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
915355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,390.40 |
| Max. Negotiated Rate |
$8,466.00 |
| Rate for Payer: Adventist Health Commercial |
$4,083.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,478.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,470.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,768.83
|
| Rate for Payer: Blue Shield of California Commercial |
$7,350.48
|
| Rate for Payer: Blue Shield of California EPN |
$4,840.56
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cash Price |
$5,478.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,466.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,716.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,071.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,165.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,390.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,972.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,972.00
|
| Rate for Payer: Multiplan Commercial |
$7,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,976.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,976.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,737.99
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.39
|
| Rate for Payer: United Healthcare HMO Rider |
$3,559.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,261.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,466.00
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
905355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,516.56 |
| Max. Negotiated Rate |
$5,371.15 |
| Rate for Payer: Adventist Health Commercial |
$2,590.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,475.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,739.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,659.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,663.42
|
| Rate for Payer: Blue Shield of California EPN |
$3,071.03
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,371.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,371.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,605.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,423.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,423.30
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,371.15
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
905355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,263.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,263.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.56
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
OP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
915355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,516.56 |
| Max. Negotiated Rate |
$5,371.15 |
| Rate for Payer: Adventist Health Commercial |
$2,590.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,475.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,739.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,659.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,663.42
|
| Rate for Payer: Blue Shield of California EPN |
$3,071.03
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,371.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,371.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,605.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,423.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,423.30
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,371.15
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
|
IP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
915355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,263.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,263.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cash Price |
$3,475.45
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,911.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.56
|
| Rate for Payer: Multiplan Commercial |
$5,055.20
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.52
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.47
|
|
|
HC SYNERCID E TEST
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912447
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Shield of California Commercial |
$56.87
|
| Rate for Payer: Blue Shield of California EPN |
$37.57
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SYNERCID E TEST
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912447
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC SYPHILIS NON TREP QUAL RPR
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900913673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$51.51
|
| Rate for Payer: Blue Shield of California EPN |
$34.03
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILIS NON TREP QUAL RPR
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900913673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC SYPHILIS NON TREP QUANT
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900913672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$42.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.48
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
