|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
915355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.16 |
| Max. Negotiated Rate |
$730.15 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$497.53
|
| Rate for Payer: Blue Shield of California Commercial |
$633.94
|
| Rate for Payer: Blue Shield of California EPN |
$417.47
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$323.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.53
|
| Rate for Payer: Blue Shield of California Commercial |
$932.09
|
| Rate for Payer: Blue Shield of California EPN |
$613.82
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$370.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
915355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
915355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.53
|
| Rate for Payer: Blue Shield of California Commercial |
$932.09
|
| Rate for Payer: Blue Shield of California EPN |
$613.82
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$370.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
OP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
915355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,890.44 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$4,592.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,160.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,487.04
|
| Rate for Payer: Blue Shield of California Commercial |
$8,265.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,443.20
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,520.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,520.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,890.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,137.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,688.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,840.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,840.00
|
| Rate for Payer: Multiplan Commercial |
$8,960.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,520.00
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
IP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
905355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,267.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,688.00
|
| Rate for Payer: Multiplan Commercial |
$8,960.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
IP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
915355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,267.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,688.00
|
| Rate for Payer: Multiplan Commercial |
$8,960.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
OP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
905355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,890.44 |
| Max. Negotiated Rate |
$9,520.00 |
| Rate for Payer: Adventist Health Commercial |
$4,592.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,160.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,487.04
|
| Rate for Payer: Blue Shield of California Commercial |
$8,265.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,443.20
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,520.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,520.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,890.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,137.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,688.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,840.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,840.00
|
| Rate for Payer: Multiplan Commercial |
$8,960.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,520.00
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
OP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
905355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$7,243.70 |
| Rate for Payer: Adventist Health Commercial |
$3,494.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,687.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,935.94
|
| Rate for Payer: Blue Shield of California Commercial |
$6,289.24
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.69
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,243.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,641.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,965.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,965.40
|
| Rate for Payer: Multiplan Commercial |
$6,817.60
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,113.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7,243.70
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
IP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
905355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,704.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,246.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.28
|
| Rate for Payer: Multiplan Commercial |
$6,817.60
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
IP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
915355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,704.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,246.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.28
|
| Rate for Payer: Multiplan Commercial |
$6,817.60
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
OP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
915355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$7,243.70 |
| Rate for Payer: Adventist Health Commercial |
$3,494.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,687.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,935.94
|
| Rate for Payer: Blue Shield of California Commercial |
$6,289.24
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.69
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,243.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,641.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,965.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,965.40
|
| Rate for Payer: Multiplan Commercial |
$6,817.60
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,113.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7,243.70
|
|
|
HC AK ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
915355642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.16
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
|
|
HC AK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
905355642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.16 |
| Max. Negotiated Rate |
$517.65 |
| Rate for Payer: Adventist Health Commercial |
$249.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.73
|
| Rate for Payer: Blue Shield of California Commercial |
$449.44
|
| Rate for Payer: Blue Shield of California EPN |
$295.97
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$517.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$517.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$517.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$426.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$426.30
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$365.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$365.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$517.65
|
| Rate for Payer: Vantage Medical Group Senior |
$517.65
|
|
|
HC AK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
915355642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.16 |
| Max. Negotiated Rate |
$517.65 |
| Rate for Payer: Adventist Health Commercial |
$249.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.73
|
| Rate for Payer: Blue Shield of California Commercial |
$449.44
|
| Rate for Payer: Blue Shield of California EPN |
$295.97
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$517.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$517.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$517.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$225.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$426.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$426.30
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$365.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$365.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$517.65
|
| Rate for Payer: Vantage Medical Group Senior |
$517.65
|
|
|
HC AK ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
905355642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.16
|
| Rate for Payer: Multiplan Commercial |
$487.20
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
905355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.32
|
| Rate for Payer: Multiplan Commercial |
$2,914.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
905355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$874.32 |
| Max. Negotiated Rate |
$3,096.55 |
| Rate for Payer: Adventist Health Commercial |
$1,493.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,732.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,110.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,688.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,770.50
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,096.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,096.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,061.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,200.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,550.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,550.10
|
| Rate for Payer: Multiplan Commercial |
$2,914.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,096.55
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
915355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$874.32 |
| Max. Negotiated Rate |
$3,096.55 |
| Rate for Payer: Adventist Health Commercial |
$1,493.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,732.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,110.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,688.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,770.50
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,096.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,096.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,061.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,200.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,550.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,550.10
|
| Rate for Payer: Multiplan Commercial |
$2,914.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,096.55
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
915355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.32
|
| Rate for Payer: Multiplan Commercial |
$2,914.40
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
|
|
HC AK ADDITION PELVIC BAND
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT L5697
|
| Hospital Charge Code |
915355697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$172.20
|
| Rate for Payer: Cigna of CA PPO |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$123.00
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.32
|
| Rate for Payer: United Healthcare All Other HMO |
$89.86
|
| Rate for Payer: United Healthcare HMO Rider |
$87.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.56
|
|
|
HC AK ADDITION PELVIC BAND
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT L5697
|
| Hospital Charge Code |
915355697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.48
|
| Rate for Payer: Blue Shield of California Commercial |
$181.55
|
| Rate for Payer: Blue Shield of California EPN |
$119.56
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$172.20
|
| Rate for Payer: Cigna of CA PPO |
$172.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$123.00
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.32
|
| Rate for Payer: United Healthcare All Other HMO |
$89.86
|
| Rate for Payer: United Healthcare HMO Rider |
$87.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC AK ADDITION PELVIC BAND
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT L5697
|
| Hospital Charge Code |
905355697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA HMO |
$172.20
|
| Rate for Payer: Cigna of CA PPO |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$123.00
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.32
|
| Rate for Payer: United Healthcare All Other HMO |
$89.86
|
| Rate for Payer: United Healthcare HMO Rider |
$87.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.56
|
|
