|
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
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
915355818
|
|
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
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
IP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
915355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$534.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$534.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,781.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,017.65
|
| 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: 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: 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
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
IP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
905355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$493.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$493.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,646.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$940.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,528.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.56
|
| Rate for Payer: Multiplan Commercial |
$1,975.20
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
OP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
915355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.56 |
| Max. Negotiated Rate |
$2,098.65 |
| Rate for Payer: Adventist Health Commercial |
$1,012.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,357.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,851.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,430.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,822.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.93
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,098.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,098.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,157.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,646.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,528.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,728.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,728.30
|
| Rate for Payer: Multiplan Commercial |
$1,975.20
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,481.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,481.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,098.65
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
OP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
905355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.56 |
| Max. Negotiated Rate |
$2,098.65 |
| Rate for Payer: Adventist Health Commercial |
$1,012.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,357.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,851.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,430.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,822.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.93
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,098.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,098.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,157.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,646.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,528.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,728.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,728.30
|
| Rate for Payer: Multiplan Commercial |
$1,975.20
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,481.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,481.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,098.65
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
IP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
915355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$493.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$493.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,646.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$940.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,528.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.56
|
| Rate for Payer: Multiplan Commercial |
$1,975.20
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
IP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
915355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,604.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,057.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,966.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,925.76
|
| Rate for Payer: Multiplan Commercial |
$6,419.20
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
IP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
905355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,604.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,057.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,966.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,925.76
|
| Rate for Payer: Multiplan Commercial |
$6,419.20
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
OP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
915355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,148.60 |
| Max. Negotiated Rate |
$6,820.40 |
| Rate for Payer: Adventist Health Commercial |
$3,289.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,413.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,018.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,647.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5,921.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,899.66
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,820.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,820.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,148.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,299.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,966.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,925.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,616.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,616.80
|
| Rate for Payer: Multiplan Commercial |
$6,419.20
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,814.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Senior |
$6,820.40
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
OP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
905355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,148.60 |
| Max. Negotiated Rate |
$6,820.40 |
| Rate for Payer: Adventist Health Commercial |
$3,289.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,413.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,018.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,647.50
|
| Rate for Payer: Blue Shield of California Commercial |
$5,921.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,899.66
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,820.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,820.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,148.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,299.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,966.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,925.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,616.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,616.80
|
| Rate for Payer: Multiplan Commercial |
$6,419.20
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,814.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Senior |
$6,820.40
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
905355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$645.98 |
| Max. Negotiated Rate |
$2,660.50 |
| Rate for Payer: Multiplan Commercial |
$2,504.00
|
| Rate for Payer: Adventist Health Commercial |
$1,283.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,347.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,812.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,521.18
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,660.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,660.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,937.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,191.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,191.00
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
915355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,937.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.20
|
| Rate for Payer: Multiplan Commercial |
$2,504.00
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
915355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$645.98 |
| Max. Negotiated Rate |
$2,660.50 |
| Rate for Payer: Adventist Health Commercial |
$1,283.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,347.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,812.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,521.18
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,660.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,660.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,937.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,191.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,191.00
|
| Rate for Payer: Multiplan Commercial |
$2,504.00
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
905355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,937.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$751.20
|
| Rate for Payer: Multiplan Commercial |
$2,504.00
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
905355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.74
|
| Rate for Payer: Blue Shield of California Commercial |
$477.49
|
| Rate for Payer: Blue Shield of California EPN |
$314.44
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
915355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
915355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.28 |
| Max. Negotiated Rate |
$549.95 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$374.74
|
| Rate for Payer: Blue Shield of California Commercial |
$477.49
|
| Rate for Payer: Blue Shield of California EPN |
$314.44
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
905355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$400.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.28
|
| Rate for Payer: Multiplan Commercial |
$517.60
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
|
|
HC AK ADD SKT INSERT SILICONE GEL
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT L5664
|
| Hospital Charge Code |
905355664
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,190.00 |
| Rate for Payer: Adventist Health Commercial |
$574.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,190.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$770.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$810.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,033.20
|
| Rate for Payer: Blue Shield of California EPN |
$680.40
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna of CA HMO |
$980.00
|
| Rate for Payer: Cigna of CA PPO |
$980.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,190.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,190.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,190.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$560.00
|
| Rate for Payer: Galaxy Health WC |
$1,190.00
|
| Rate for Payer: Global Benefits Group Commercial |
$840.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$933.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$866.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$980.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$980.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: Networks By Design Commercial |
$700.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$840.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$525.42
|
| Rate for Payer: United Healthcare All Other HMO |
$511.42
|
| Rate for Payer: United Healthcare HMO Rider |
$500.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,190.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,190.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,190.00
|
|
|
HC AK ADD SKT INSERT SILICONE GEL
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT L5664
|
| Hospital Charge Code |
905355664
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$280.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Cigna of CA HMO |
$980.00
|
| Rate for Payer: Cigna of CA PPO |
$980.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$560.00
|
| Rate for Payer: Galaxy Health WC |
$1,190.00
|
| Rate for Payer: Global Benefits Group Commercial |
$840.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$933.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$866.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: Networks By Design Commercial |
$700.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$525.42
|
| Rate for Payer: United Healthcare All Other HMO |
$511.42
|
| Rate for Payer: United Healthcare HMO Rider |
$500.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
905355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$5,860.75 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,993.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,088.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,350.97
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,088.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,362.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
915355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,626.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
905355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,626.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
915355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$5,860.75 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,993.58
|
| Rate for Payer: Blue Shield of California Commercial |
$5,088.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,350.97
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,088.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,362.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
