|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$493.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,567.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.71
|
| 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 |
$1,604.85
|
| 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 |
$1,494.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,898.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,251.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,157.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,567.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.71
|
| 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 |
$1,494.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,898.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,251.78
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,157.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,567.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.71
|
| 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 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 |
$4,856.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,170.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4,068.17
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,148.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,299.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| 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 |
$5,215.60
|
| 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 |
905355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,148.60 |
| Max. Negotiated Rate |
$6,820.40 |
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| 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 |
$4,856.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,170.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4,068.17
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,148.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,299.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,604.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| 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 |
$5,215.60
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| 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 |
$2,034.50
|
| 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 |
$1,894.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,406.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,586.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| 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
|
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: 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 |
$1,894.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,406.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,586.91
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| 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 |
915355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| 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 |
$2,034.50
|
| 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 |
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 |
$391.63
|
| Rate for Payer: Blue Shield of California Commercial |
$497.54
|
| Rate for Payer: Blue Shield of California Commercial |
$328.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| 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
|
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 |
$391.63
|
| Rate for Payer: Blue Shield of California Commercial |
$497.54
|
| Rate for Payer: Blue Shield of California Commercial |
$328.03
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| 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 |
$420.55
|
| 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
|
IP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
915355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| 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 |
$420.55
|
| 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
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT L5664
|
| Hospital Charge Code |
905355664
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$280.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$889.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.00
|
| 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 |
$910.00
|
| 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 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 |
$847.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,076.60
|
| Rate for Payer: Blue Shield of California Commercial |
$709.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$889.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$508.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.00
|
| 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 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 |
$4,173.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5,302.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,495.76
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,088.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,362.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| 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 |
905355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| 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 |
$4,481.75
|
| 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 |
915355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| 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 |
$4,481.75
|
| 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 |
$4,173.54
|
| Rate for Payer: Blue Shield of California Commercial |
$5,302.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,495.76
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,088.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,362.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| 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 MAN LOCK ULTR
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$432.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$518.88 |
| Max. Negotiated Rate |
$1,837.70 |
| Rate for Payer: Adventist Health Commercial |
$886.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,189.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,308.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,662.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,096.13
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,837.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,837.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,048.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,185.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,513.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,513.40
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,837.70
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
915355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$432.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
915355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$518.88 |
| Max. Negotiated Rate |
$1,837.70 |
| Rate for Payer: Adventist Health Commercial |
$886.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,189.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,308.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,662.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,096.13
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,837.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,837.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,048.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,185.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,513.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,513.40
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,837.70
|
|
