|
HC SWEAT CHLORIDE MEASUREMENT
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
900910680
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$43.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.37
|
| Rate for Payer: BCBS Transplant Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$11.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.23
|
| Rate for Payer: Caremore Medicare Advantage |
$5.00
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.00
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.20
|
| Rate for Payer: IEHP medi-cal |
$8.25
|
| Rate for Payer: IEHP Medicare Advantage |
$5.00
|
| Rate for Payer: Innovage PACE Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Medicare |
$5.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: Riverside University Health MISP |
$5.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.05
|
| Rate for Payer: United Healthcare All Other HMO |
$4.05
|
| Rate for Payer: United Healthcare HMO Rider |
$4.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5.00
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
OP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
905355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.75 |
| Max. Negotiated Rate |
$1,985.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,985.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$599.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$387.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$387.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$341.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.51
|
| Rate for Payer: BCBS Transplant Transplant |
$423.00
|
| Rate for Payer: Blue Shield of California Commercial |
$528.75
|
| Rate for Payer: Blue Shield of California EPN |
$383.52
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Central Health Plan Commercial |
$564.00
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$599.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$634.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$528.75
|
| Rate for Payer: IEHP medi-cal |
$246.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.05
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
| Rate for Payer: Riverside University Health MISP |
$282.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.50
|
| Rate for Payer: United Healthcare All Other HMO |
$352.50
|
| Rate for Payer: United Healthcare HMO Rider |
$352.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$599.25
|
| Rate for Payer: Vantage Medical Group Senior |
$599.25
|
|
|
HC SYMES ADD EXPAND WALL SOCKET
|
Facility
IP
|
$705.00
|
|
|
Service Code
|
CPT L5630
|
| Hospital Charge Code |
905355630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$141.00 |
| Max. Negotiated Rate |
$634.50 |
| Rate for Payer: Blue Shield of California EPN |
$376.47
|
| Rate for Payer: Cash Price |
$317.25
|
| Rate for Payer: Central Health Plan Commercial |
$564.00
|
| Rate for Payer: Cigna of CA HMO |
$493.50
|
| Rate for Payer: Cigna of CA PPO |
$493.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$282.00
|
| Rate for Payer: Galaxy Health WC |
$599.25
|
| Rate for Payer: Global Benefits Group Commercial |
$423.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$634.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$141.00
|
| Rate for Payer: Multiplan Commercial |
$528.75
|
| Rate for Payer: Networks By Design Commercial |
$352.50
|
| Rate for Payer: Prime Health Services Commercial |
$599.25
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
OP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
905355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$982.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$982.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$223.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.86
|
| Rate for Payer: BCBS Transplant Transplant |
$243.60
|
| Rate for Payer: Blue Shield of California Commercial |
$304.50
|
| Rate for Payer: Blue Shield of California EPN |
$220.86
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$304.50
|
| Rate for Payer: IEHP medi-cal |
$142.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.46
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Riverside University Health MISP |
$162.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
905355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Blue Shield of California EPN |
$216.80
|
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$284.20
|
| Rate for Payer: Cigna of CA PPO |
$284.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$203.00
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
905355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,243.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,243.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.22
|
| Rate for Payer: BCBS Transplant Transplant |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$390.00
|
| Rate for Payer: Blue Shield of California EPN |
$282.88
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$390.00
|
| Rate for Payer: IEHP medi-cal |
$182.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$260.00
|
| Rate for Payer: United Healthcare HMO Rider |
$260.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
905355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Blue Shield of California EPN |
$277.68
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
|
|
HC SYMES ADD MEDIAL OPEN SOCKET
|
Facility
IP
|
$438.00
|
|
|
Service Code
|
CPT L5636
|
| Hospital Charge Code |
905355636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Blue Shield of California EPN |
$233.89
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
|
|
HC SYMES ADD MEDIAL OPEN SOCKET
|
Facility
OP
|
$438.00
|
|
|
Service Code
|
CPT L5636
|
| Hospital Charge Code |
905355636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$1,127.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,127.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$240.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$212.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.77
|
| Rate for Payer: BCBS Transplant Transplant |
$262.80
|
| Rate for Payer: Blue Shield of California Commercial |
$328.50
|
| Rate for Payer: Blue Shield of California EPN |
$238.27
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$328.50
|
| Rate for Payer: IEHP medi-cal |
$153.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.58
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Riverside University Health MISP |
$175.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.00
|
| Rate for Payer: United Healthcare All Other HMO |
$219.00
|
| Rate for Payer: United Healthcare HMO Rider |
$219.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC SYMES ADD POSTERIOR OPEN SOCKT
|
Facility
OP
|
$869.00
|
|
|
Service Code
|
CPT L5634
|
| Hospital Charge Code |
905355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.15 |
| Max. Negotiated Rate |
$1,345.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,345.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$477.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$420.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$513.41
|
| Rate for Payer: BCBS Transplant Transplant |
$521.40
|
| Rate for Payer: Blue Shield of California Commercial |
$651.75
|
| Rate for Payer: Blue Shield of California EPN |
$472.74
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$651.75
|
| Rate for Payer: IEHP medi-cal |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.29
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: Riverside University Health MISP |
$347.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$521.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$521.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.50
|
| Rate for Payer: United Healthcare All Other HMO |
$434.50
|
| Rate for Payer: United Healthcare HMO Rider |
$434.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$738.65
|
|
|
HC SYMES ADD POSTERIOR OPEN SOCKT
|
Facility
IP
|
$869.00
|
|
|
Service Code
|
CPT L5634
|
| Hospital Charge Code |
905355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Blue Shield of California EPN |
$464.05
|
| Rate for Payer: Cash Price |
$391.05
|
| Rate for Payer: Central Health Plan Commercial |
$695.20
|
| Rate for Payer: Cigna of CA HMO |
$608.30
|
| Rate for Payer: Cigna of CA PPO |
$608.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$347.60
|
| Rate for Payer: Galaxy Health WC |
$738.65
|
| Rate for Payer: Global Benefits Group Commercial |
$521.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$782.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.80
|
| Rate for Payer: Multiplan Commercial |
$651.75
|
| Rate for Payer: Networks By Design Commercial |
$434.50
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
|
|
HC SYMES ADD SKT INSRT-PELITE LIN
|
Facility
OP
|
$655.00
|
|
|
Service Code
|
CPT L5654
|
| Hospital Charge Code |
905355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.25 |
| Max. Negotiated Rate |
$1,466.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,466.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$360.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$360.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$317.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.97
|
| Rate for Payer: BCBS Transplant Transplant |
$393.00
|
| Rate for Payer: Blue Shield of California Commercial |
$491.25
|
| Rate for Payer: Blue Shield of California EPN |
$356.32
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Central Health Plan Commercial |
$524.00
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$556.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$589.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$491.25
|
| Rate for Payer: IEHP medi-cal |
$229.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.55
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
| Rate for Payer: Networks By Design Commercial |
$327.50
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: Riverside University Health MISP |
$262.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$393.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$327.50
|
| Rate for Payer: United Healthcare All Other HMO |
$327.50
|
| Rate for Payer: United Healthcare HMO Rider |
$327.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$556.75
|
| Rate for Payer: Vantage Medical Group Senior |
$556.75
|
|
|
HC SYMES ADD SKT INSRT-PELITE LIN
|
Facility
IP
|
$655.00
|
|
|
Service Code
|
CPT L5654
|
| Hospital Charge Code |
905355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Blue Shield of California EPN |
$349.77
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: Central Health Plan Commercial |
$524.00
|
| Rate for Payer: Cigna of CA HMO |
$458.50
|
| Rate for Payer: Cigna of CA PPO |
$458.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$589.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.00
|
| Rate for Payer: Multiplan Commercial |
$491.25
|
| Rate for Payer: Networks By Design Commercial |
$327.50
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
|
|
HC SYMES ADD SKT INST MULTI-DUROM
|
Facility
OP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
905355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$452.20 |
| Max. Negotiated Rate |
$2,691.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,691.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$710.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$625.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$763.31
|
| Rate for Payer: BCBS Transplant Transplant |
$775.20
|
| Rate for Payer: Blue Shield of California Commercial |
$969.00
|
| Rate for Payer: Blue Shield of California EPN |
$702.85
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,033.60
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$516.80
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,162.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$969.00
|
| Rate for Payer: IEHP medi-cal |
$452.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.72
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
| Rate for Payer: Networks By Design Commercial |
$646.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: Riverside University Health MISP |
$516.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$775.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$775.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$646.00
|
| Rate for Payer: United Healthcare All Other HMO |
$646.00
|
| Rate for Payer: United Healthcare HMO Rider |
$646.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$646.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,098.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,098.20
|
|
|
HC SYMES ADD SKT INST MULTI-DUROM
|
Facility
IP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
905355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Blue Shield of California EPN |
$689.93
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,033.60
|
| Rate for Payer: Cigna of CA HMO |
$904.40
|
| Rate for Payer: Cigna of CA PPO |
$904.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$516.80
|
| Rate for Payer: Galaxy Health WC |
$1,098.20
|
| Rate for Payer: Global Benefits Group Commercial |
$775.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,162.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.40
|
| Rate for Payer: Multiplan Commercial |
$969.00
|
| Rate for Payer: Networks By Design Commercial |
$646.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
|
|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
OP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
905355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,410.50 |
| Max. Negotiated Rate |
$9,252.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,252.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,425.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,216.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,216.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,951.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,380.92
|
| Rate for Payer: BCBS Transplant Transplant |
$2,418.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,022.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,192.32
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,612.00
|
| Rate for Payer: Galaxy Health WC |
$3,425.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,418.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,627.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,022.50
|
| Rate for Payer: IEHP medi-cal |
$1,410.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.30
|
| Rate for Payer: Multiplan Commercial |
$3,022.50
|
| Rate for Payer: Networks By Design Commercial |
$2,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: Riverside University Health MISP |
$1,612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,418.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,418.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,015.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,015.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,015.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,015.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,425.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,425.50
|
|
|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
IP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
905355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$3,627.00 |
| Rate for Payer: Blue Shield of California EPN |
$2,152.02
|
| Rate for Payer: Cash Price |
$1,813.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,224.00
|
| Rate for Payer: Cigna of CA HMO |
$2,821.00
|
| Rate for Payer: Cigna of CA PPO |
$2,821.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,612.00
|
| Rate for Payer: Galaxy Health WC |
$3,425.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,418.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,627.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$806.00
|
| Rate for Payer: Multiplan Commercial |
$3,022.50
|
| Rate for Payer: Networks By Design Commercial |
$2,015.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
IP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
905355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,992.00 |
| Max. Negotiated Rate |
$8,964.00 |
| Rate for Payer: Blue Shield of California EPN |
$5,318.64
|
| Rate for Payer: Cash Price |
$4,482.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,968.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,964.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,992.00
|
| Rate for Payer: Multiplan Commercial |
$7,470.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
|
|
HC SYMES MET FRM MOLD LEATH SOCKT
|
Facility
OP
|
$9,960.00
|
|
|
Service Code
|
CPT L5060
|
| Hospital Charge Code |
905355060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,486.00 |
| Max. Negotiated Rate |
$12,216.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,216.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,466.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,478.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,478.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,822.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,884.37
|
| Rate for Payer: BCBS Transplant Transplant |
$5,976.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,470.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,418.24
|
| Rate for Payer: Cash Price |
$4,482.00
|
| Rate for Payer: Cash Price |
$4,482.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,968.00
|
| Rate for Payer: Cigna of CA HMO |
$6,972.00
|
| Rate for Payer: Cigna of CA PPO |
$6,972.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,466.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,984.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,984.00
|
| Rate for Payer: Galaxy Health WC |
$8,466.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,976.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,964.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,470.00
|
| Rate for Payer: IEHP medi-cal |
$3,486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,643.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,083.60
|
| Rate for Payer: Multiplan Commercial |
$7,470.00
|
| Rate for Payer: Networks By Design Commercial |
$4,980.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,466.00
|
| Rate for Payer: Riverside University Health MISP |
$3,984.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,976.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,976.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,980.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,980.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,980.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,466.00
|
| Rate for Payer: Vantage Medical Group Senior |
$8,466.00
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
OP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
905355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,211.65 |
| Max. Negotiated Rate |
$10,150.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,150.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,371.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,475.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,475.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,059.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,733.27
|
| Rate for Payer: BCBS Transplant Transplant |
$3,791.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,739.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,437.54
|
| Rate for Payer: Cash Price |
$2,843.55
|
| Rate for Payer: Cash Price |
$2,843.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,055.20
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,371.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,687.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,739.25
|
| Rate for Payer: IEHP medi-cal |
$2,211.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,590.79
|
| Rate for Payer: Multiplan Commercial |
$4,739.25
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
| Rate for Payer: Riverside University Health MISP |
$2,527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,159.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,159.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,159.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,159.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,371.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,371.15
|
|
|
HC SYMES MOLDED SOCKET SACH FOOT
|
Facility
IP
|
$6,319.00
|
|
|
Service Code
|
CPT L5050
|
| Hospital Charge Code |
905355050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,263.80 |
| Max. Negotiated Rate |
$5,687.10 |
| Rate for Payer: Blue Shield of California EPN |
$3,374.35
|
| Rate for Payer: Cash Price |
$2,843.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,055.20
|
| Rate for Payer: Cigna of CA HMO |
$4,423.30
|
| Rate for Payer: Cigna of CA PPO |
$4,423.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,527.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,527.60
|
| Rate for Payer: Galaxy Health WC |
$5,371.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,687.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,214.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.80
|
| Rate for Payer: Multiplan Commercial |
$4,739.25
|
| Rate for Payer: Networks By Design Commercial |
$3,159.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,371.15
|
|
|
HC SYNERCID E TEST
|
Facility
IP
|
$87.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912447
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC SYNERCID E TEST
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912447
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.01
|
| Rate for Payer: BCBS Transplant Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Caremore Medicare Advantage |
$4.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: IEHP medi-cal |
$7.84
|
| Rate for Payer: IEHP Medicare Advantage |
$4.75
|
| Rate for Payer: Innovage PACE Commercial |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.04
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: Riverside University Health MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SYPHILIS NON TREP QUAL RPR
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900913673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC SYPHILIS NON TREP QUAL RPR
|
Facility
OP
|
$39.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900913673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$37.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.88
|
| Rate for Payer: BCBS Transplant Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.00
|
| Rate for Payer: IEHP medi-cal |
$7.05
|
| Rate for Payer: IEHP Medicare Advantage |
$4.27
|
| Rate for Payer: Innovage PACE Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$4.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: Riverside University Health MISP |
$4.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
