|
HC AK ADDITION PELVIC BAND
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT L5697
|
| Hospital Charge Code |
905355697
|
|
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 JOINT
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT L5696
|
| Hospital Charge Code |
915355696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$499.80 |
| Rate for Payer: Adventist Health Commercial |
$241.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$499.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$323.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$441.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.57
|
| Rate for Payer: Blue Shield of California Commercial |
$433.94
|
| Rate for Payer: Blue Shield of California EPN |
$285.77
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna of CA HMO |
$411.60
|
| Rate for Payer: Cigna of CA PPO |
$411.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$499.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$235.20
|
| Rate for Payer: Galaxy Health WC |
$499.80
|
| Rate for Payer: Global Benefits Group Commercial |
$352.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.60
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: Networks By Design Commercial |
$294.00
|
| Rate for Payer: Prime Health Services Commercial |
$499.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$352.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$352.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.68
|
| Rate for Payer: United Healthcare All Other HMO |
$214.80
|
| Rate for Payer: United Healthcare HMO Rider |
$210.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$499.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.80
|
| Rate for Payer: Vantage Medical Group Senior |
$499.80
|
|
|
HC AK ADDITION PELVIC JOINT
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT L5696
|
| Hospital Charge Code |
915355696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$117.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna of CA HMO |
$411.60
|
| Rate for Payer: Cigna of CA PPO |
$411.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$235.20
|
| Rate for Payer: Galaxy Health WC |
$499.80
|
| Rate for Payer: Global Benefits Group Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.12
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: Networks By Design Commercial |
$294.00
|
| Rate for Payer: Prime Health Services Commercial |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.68
|
| Rate for Payer: United Healthcare All Other HMO |
$214.80
|
| Rate for Payer: United Healthcare HMO Rider |
$210.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.57
|
|
|
HC AK ADDITION PELVIC JOINT
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT L5696
|
| Hospital Charge Code |
905355696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.12 |
| Max. Negotiated Rate |
$499.80 |
| Rate for Payer: Adventist Health Commercial |
$241.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$499.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$323.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$441.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.57
|
| Rate for Payer: Blue Shield of California Commercial |
$433.94
|
| Rate for Payer: Blue Shield of California EPN |
$285.77
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna of CA HMO |
$411.60
|
| Rate for Payer: Cigna of CA PPO |
$411.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$499.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$235.20
|
| Rate for Payer: Galaxy Health WC |
$499.80
|
| Rate for Payer: Global Benefits Group Commercial |
$352.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.60
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: Networks By Design Commercial |
$294.00
|
| Rate for Payer: Prime Health Services Commercial |
$499.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$352.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$352.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.68
|
| Rate for Payer: United Healthcare All Other HMO |
$214.80
|
| Rate for Payer: United Healthcare HMO Rider |
$210.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$499.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.80
|
| Rate for Payer: Vantage Medical Group Senior |
$499.80
|
|
|
HC AK ADDITION PELVIC JOINT
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT L5696
|
| Hospital Charge Code |
905355696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$117.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cigna of CA HMO |
$411.60
|
| Rate for Payer: Cigna of CA PPO |
$411.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$235.20
|
| Rate for Payer: Galaxy Health WC |
$499.80
|
| Rate for Payer: Global Benefits Group Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.12
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: Networks By Design Commercial |
$294.00
|
| Rate for Payer: Prime Health Services Commercial |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.68
|
| Rate for Payer: United Healthcare All Other HMO |
$214.80
|
| Rate for Payer: United Healthcare HMO Rider |
$210.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.57
|
|
|
HC AK ADDITION SAFETY KNEE
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
905355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$623.52 |
| Max. Negotiated Rate |
$2,208.30 |
| Rate for Payer: Adventist Health Commercial |
$1,065.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,428.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,948.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,504.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,917.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,262.63
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,208.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$660.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,732.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,608.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,818.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,818.60
|
| Rate for Payer: Multiplan Commercial |
$2,078.40
|
| Rate for Payer: Networks By Design Commercial |
$1,299.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,558.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,558.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.03
|
| Rate for Payer: United Healthcare All Other HMO |
$949.05
|
| Rate for Payer: United Healthcare HMO Rider |
$928.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$850.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,208.30
|
|
|
HC AK ADDITION SAFETY KNEE
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
905355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$519.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,732.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$989.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,608.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.52
|
| Rate for Payer: Multiplan Commercial |
$2,078.40
|
| Rate for Payer: Networks By Design Commercial |
$1,299.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.03
|
| Rate for Payer: United Healthcare All Other HMO |
$949.05
|
| Rate for Payer: United Healthcare HMO Rider |
$928.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$850.85
|
|
|
HC AK ADDITION SAFETY KNEE
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
915355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$519.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,732.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$989.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,608.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.52
|
| Rate for Payer: Multiplan Commercial |
$2,078.40
|
| Rate for Payer: Networks By Design Commercial |
$1,299.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.03
|
| Rate for Payer: United Healthcare All Other HMO |
$949.05
|
| Rate for Payer: United Healthcare HMO Rider |
$928.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$850.85
|
|
|
HC AK ADDITION SAFETY KNEE
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
915355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$623.52 |
| Max. Negotiated Rate |
$2,208.30 |
| Rate for Payer: Adventist Health Commercial |
$1,065.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,428.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,948.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,504.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,917.32
|
| Rate for Payer: Blue Shield of California EPN |
$1,262.63
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,208.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$660.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,732.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,608.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$623.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,818.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,818.60
|
| Rate for Payer: Multiplan Commercial |
$2,078.40
|
| Rate for Payer: Networks By Design Commercial |
$1,299.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,558.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,558.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.03
|
| Rate for Payer: United Healthcare All Other HMO |
$949.05
|
| Rate for Payer: United Healthcare HMO Rider |
$928.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$850.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,208.30
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
915355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
905355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.66
|
| Rate for Payer: Blue Shield of California Commercial |
$225.09
|
| Rate for Payer: Blue Shield of California EPN |
$148.23
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
905355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
915355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$259.25 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.66
|
| Rate for Payer: Blue Shield of California Commercial |
$225.09
|
| Rate for Payer: Blue Shield of California EPN |
$148.23
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$82.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$244.00
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
915355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.42 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Adventist Health Commercial |
$360.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.70
|
| Rate for Payer: Blue Shield of California Commercial |
$649.44
|
| Rate for Payer: Blue Shield of California EPN |
$427.68
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$544.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$616.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$616.00
|
| Rate for Payer: Multiplan Commercial |
$704.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.00
|
| Rate for Payer: Vantage Medical Group Senior |
$748.00
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
915355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$176.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$544.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$704.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
905355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.42 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Adventist Health Commercial |
$360.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.70
|
| Rate for Payer: Blue Shield of California Commercial |
$649.44
|
| Rate for Payer: Blue Shield of California EPN |
$427.68
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$136.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$544.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$616.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$616.00
|
| Rate for Payer: Multiplan Commercial |
$704.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.00
|
| Rate for Payer: Vantage Medical Group Senior |
$748.00
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
905355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$176.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$544.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.20
|
| Rate for Payer: Multiplan Commercial |
$704.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
905355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
915355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
905355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$404.28
|
| Rate for Payer: Blue Shield of California Commercial |
$515.12
|
| Rate for Payer: Blue Shield of California EPN |
$339.23
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$251.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
915355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$404.28
|
| Rate for Payer: Blue Shield of California Commercial |
$515.12
|
| Rate for Payer: Blue Shield of California EPN |
$339.23
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$251.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
915355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
905355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
915355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$268.32 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$458.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.55
|
| Rate for Payer: Blue Shield of California Commercial |
$825.08
|
| Rate for Payer: Blue Shield of California EPN |
$543.35
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$782.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
905355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$268.32 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Adventist Health Commercial |
$458.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.55
|
| Rate for Payer: Blue Shield of California Commercial |
$825.08
|
| Rate for Payer: Blue Shield of California EPN |
$543.35
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$342.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$782.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
