|
HC BK ADDITION AIR CUSSION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
915355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC BK ADDITION AIR CUSSION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
905355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC BK ADDITION AIR CUSSION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
905355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.53
|
| Rate for Payer: Blue Shield of California Commercial |
$932.09
|
| Rate for Payer: Blue Shield of California EPN |
$613.82
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$347.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
915355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.14
|
| Rate for Payer: Blue Shield of California Commercial |
$94.46
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
905355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
905355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$108.80 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.14
|
| Rate for Payer: Blue Shield of California Commercial |
$94.46
|
| Rate for Payer: Blue Shield of California EPN |
$62.21
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
915355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
915355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.57
|
| Rate for Payer: Blue Shield of California Commercial |
$135.79
|
| Rate for Payer: Blue Shield of California EPN |
$89.42
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
905355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
905355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.57
|
| Rate for Payer: Blue Shield of California Commercial |
$135.79
|
| Rate for Payer: Blue Shield of California EPN |
$89.42
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
915355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
915355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.45
|
| Rate for Payer: Blue Shield of California Commercial |
$83.39
|
| Rate for Payer: Blue Shield of California EPN |
$54.92
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.10
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
905355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
915355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
905355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$96.05 |
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.45
|
| Rate for Payer: Blue Shield of California Commercial |
$83.39
|
| Rate for Payer: Blue Shield of California EPN |
$54.92
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$55.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.10
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
915355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.23
|
| Rate for Payer: Blue Shield of California Commercial |
$62.73
|
| Rate for Payer: Blue Shield of California EPN |
$41.31
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.50
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
905355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$72.25 |
| Rate for Payer: Adventist Health Commercial |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.23
|
| Rate for Payer: Blue Shield of California Commercial |
$62.73
|
| Rate for Payer: Blue Shield of California EPN |
$41.31
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.50
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
915355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
905355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
915355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.28 |
| Max. Negotiated Rate |
$804.95 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.50
|
| Rate for Payer: Blue Shield of California Commercial |
$698.89
|
| Rate for Payer: Blue Shield of California EPN |
$460.24
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$550.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
905355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.28 |
| Max. Negotiated Rate |
$804.95 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.50
|
| Rate for Payer: Blue Shield of California Commercial |
$698.89
|
| Rate for Payer: Blue Shield of California EPN |
$460.24
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$550.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
915355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
905355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.28
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
915355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$364.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.28
|
| Rate for Payer: Multiplan Commercial |
$1,457.60
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
905355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$437.28 |
| Max. Negotiated Rate |
$1,548.70 |
| Rate for Payer: Adventist Health Commercial |
$747.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,002.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,366.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,055.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,344.64
|
| Rate for Payer: Blue Shield of California EPN |
$885.49
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,548.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,548.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$906.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,275.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,275.40
|
| Rate for Payer: Multiplan Commercial |
$1,457.60
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,093.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,548.70
|
|
