|
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 |
$314.76
|
| Rate for Payer: Blue Shield of California Commercial |
$399.88
|
| Rate for Payer: Blue Shield of California Commercial |
$263.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| 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 |
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 |
$314.76
|
| Rate for Payer: Blue Shield of California Commercial |
$399.88
|
| Rate for Payer: Blue Shield of California Commercial |
$263.64
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| 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 |
915355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| 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 |
$338.00
|
| 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
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
905355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| 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 |
$338.00
|
| 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 |
905355636
|
|
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 |
$265.12
|
| Rate for Payer: Blue Shield of California Commercial |
$336.82
|
| Rate for Payer: Blue Shield of California Commercial |
$222.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$190.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| 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
|
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 |
$265.12
|
| Rate for Payer: Blue Shield of California Commercial |
$336.82
|
| Rate for Payer: Blue Shield of California Commercial |
$222.07
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$190.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| 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 |
$284.70
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| 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 |
$284.70
|
| 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 POSTERIOR OPEN SOCKT
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT L5634
|
| Hospital Charge Code |
905355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.56 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Adventist Health Commercial |
$356.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.01
|
| Rate for Payer: Blue Shield of California Commercial |
$668.26
|
| Rate for Payer: Blue Shield of California Commercial |
$440.58
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$382.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$432.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC SYMES ADD POSTERIOR OPEN SOCKT
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT L5634
|
| Hospital Charge Code |
915355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
|
|
HC SYMES ADD POSTERIOR OPEN SOCKT
|
Facility
|
IP
|
$869.00
|
|
|
Service Code
|
CPT L5634
|
| Hospital Charge Code |
905355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
|
|
HC SYMES ADD POSTERIOR OPEN SOCKT
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT L5634
|
| Hospital Charge Code |
915355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.56 |
| Max. Negotiated Rate |
$738.65 |
| Rate for Payer: Adventist Health Commercial |
$356.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.01
|
| Rate for Payer: Blue Shield of California Commercial |
$668.26
|
| Rate for Payer: Blue Shield of California Commercial |
$440.58
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$382.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$432.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
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 |
$396.47
|
| Rate for Payer: Blue Shield of California Commercial |
$503.69
|
| Rate for Payer: Blue Shield of California Commercial |
$332.08
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$303.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.45
|
| 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 |
915355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.45
|
| 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 |
$425.75
|
| 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 |
905355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.45
|
| 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 |
$425.75
|
| 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 |
$396.47
|
| Rate for Payer: Blue Shield of California Commercial |
$503.69
|
| Rate for Payer: Blue Shield of California Commercial |
$332.08
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$303.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.45
|
| 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 |
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 |
$782.05
|
| Rate for Payer: Blue Shield of California Commercial |
$993.55
|
| Rate for Payer: Blue Shield of California Commercial |
$655.04
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$579.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$820.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$762.28
|
| 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 |
905355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$820.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$762.28
|
| 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 |
$839.80
|
| 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 |
915355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$820.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$762.28
|
| 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 |
$839.80
|
| 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 |
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 |
$782.05
|
| Rate for Payer: Blue Shield of California Commercial |
$993.55
|
| Rate for Payer: Blue Shield of California Commercial |
$655.04
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$579.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$820.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$655.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$762.28
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,559.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,377.70
|
| 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 |
$2,619.50
|
| 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 |
$2,439.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3,099.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,043.21
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,813.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,594.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,559.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,934.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,377.70
|
| 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 |
$2,439.36
|
| Rate for Payer: Blue Shield of California Commercial |
$3,099.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,043.21
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,813.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,594.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,559.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,934.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,377.70
|
| 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
|
IP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
915355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,559.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,377.70
|
| 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 |
$2,619.50
|
| 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 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 |
$6,028.79
|
| Rate for Payer: Blue Shield of California Commercial |
$7,659.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,049.72
|
| Rate for Payer: Cash Price |
$4,482.00
|
| Rate for Payer: Cash Price |
$4,482.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,716.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,324.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,071.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,876.40
|
| 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
|
|
