|
HC AK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
915355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$13,501.00 |
| 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: Networks By Design Commercial |
$304.50
|
| 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 WOOD SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$13,501.00 |
| 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: Networks By Design Commercial |
$304.50
|
| 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 WOOD SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
915355644
|
|
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 WOOD SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
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 ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
OP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
915355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,056.56 |
| Max. Negotiated Rate |
$7,283.65 |
| Rate for Payer: Adventist Health Commercial |
$3,513.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,712.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,963.16
|
| Rate for Payer: Blue Shield of California Commercial |
$6,323.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,164.53
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,283.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,283.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,256.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,998.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,998.30
|
| Rate for Payer: Multiplan Commercial |
$6,855.20
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,283.65
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
OP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,056.56 |
| Max. Negotiated Rate |
$7,283.65 |
| Rate for Payer: Adventist Health Commercial |
$3,513.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,712.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,963.16
|
| Rate for Payer: Blue Shield of California Commercial |
$6,323.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,164.53
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,283.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,283.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,256.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,998.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,998.30
|
| Rate for Payer: Multiplan Commercial |
$6,855.20
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,283.65
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
915355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,713.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,264.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.56
|
| Rate for Payer: Multiplan Commercial |
$6,855.20
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,713.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,264.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,056.56
|
| Rate for Payer: Multiplan Commercial |
$6,855.20
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$64.50
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.41
|
| Rate for Payer: United Healthcare All Other HMO |
$47.12
|
| Rate for Payer: United Healthcare HMO Rider |
$46.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.25
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
915355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.96 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: Adventist Health Commercial |
$165.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.00
|
| Rate for Payer: Blue Shield of California Commercial |
$298.15
|
| Rate for Payer: Blue Shield of California EPN |
$196.34
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$202.00
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
915355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$202.00
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.96 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Adventist Health Commercial |
$52.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.72
|
| Rate for Payer: Blue Shield of California Commercial |
$95.20
|
| Rate for Payer: Blue Shield of California EPN |
$62.69
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Networks By Design Commercial |
$64.50
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.41
|
| Rate for Payer: United Healthcare All Other HMO |
$47.12
|
| Rate for Payer: United Healthcare HMO Rider |
$46.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
915355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.92
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.92
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
915355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$389.30 |
| Rate for Payer: Adventist Health Commercial |
$187.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.27
|
| Rate for Payer: Blue Shield of California Commercial |
$338.00
|
| Rate for Payer: Blue Shield of California EPN |
$222.59
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$389.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.92 |
| Max. Negotiated Rate |
$389.30 |
| Rate for Payer: Adventist Health Commercial |
$187.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.27
|
| Rate for Payer: Blue Shield of California Commercial |
$338.00
|
| Rate for Payer: Blue Shield of California EPN |
$222.59
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$389.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
915355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$310.25 |
| Rate for Payer: Adventist Health Commercial |
$149.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.41
|
| Rate for Payer: Blue Shield of California Commercial |
$269.37
|
| Rate for Payer: Blue Shield of California EPN |
$177.39
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$255.50
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$310.25 |
| Rate for Payer: Adventist Health Commercial |
$149.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.41
|
| Rate for Payer: Blue Shield of California Commercial |
$269.37
|
| Rate for Payer: Blue Shield of California EPN |
$177.39
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$255.50
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
915355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
OP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
905355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,573.68 |
| Max. Negotiated Rate |
$5,573.45 |
| Rate for Payer: Adventist Health Commercial |
$2,688.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,606.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,917.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,797.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,839.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,186.70
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,573.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,573.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,726.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,084.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,058.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,573.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,589.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,589.90
|
| Rate for Payer: Multiplan Commercial |
$5,245.60
|
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,934.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,934.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,573.45
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
IP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
915355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,311.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,498.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,058.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,573.68
|
| Rate for Payer: Multiplan Commercial |
$5,245.60
|
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
IP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
905355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,311.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,498.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,058.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,573.68
|
| Rate for Payer: Multiplan Commercial |
$5,245.60
|
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
OP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
915355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,573.68 |
| Max. Negotiated Rate |
$5,573.45 |
| Rate for Payer: Adventist Health Commercial |
$2,688.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,606.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,917.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,797.81
|
| Rate for Payer: Blue Shield of California Commercial |
$4,839.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,186.70
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,573.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,573.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,726.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,084.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,058.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,573.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,589.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,589.90
|
| Rate for Payer: Multiplan Commercial |
$5,245.60
|
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,934.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,934.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,573.45
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
905355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$641.04 |
| Max. Negotiated Rate |
$2,270.35 |
| Rate for Payer: Adventist Health Commercial |
$1,095.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,469.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,547.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,971.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,298.11
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,270.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,270.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,224.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,781.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,384.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,653.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$641.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,869.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,869.70
|
| Rate for Payer: Multiplan Commercial |
$2,136.80
|
| Rate for Payer: Networks By Design Commercial |
$1,335.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,602.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,602.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.43
|
| Rate for Payer: United Healthcare All Other HMO |
$975.72
|
| Rate for Payer: United Healthcare HMO Rider |
$954.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,270.35
|
|
