|
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: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Blue Shield of California Commercial |
$313.84
|
| Rate for Payer: Blue Shield of California EPN |
$204.62
|
| Rate for Payer: Cash Price |
$223.30
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| 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 |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
|
|
HC SYMES ADDITION PTB BRIM DESIGN
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT L5632
|
| Hospital Charge Code |
915355632
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.97 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$166.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.44
|
| Rate for Payer: Blue Shield of California Commercial |
$313.84
|
| Rate for Payer: Blue Shield of California EPN |
$204.62
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| 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: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$138.79
|
| Rate for Payer: InnovAge PACE Commercial |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$152.37
|
| Rate for Payer: United Healthcare All Other HMO |
$148.31
|
| Rate for Payer: United Healthcare HMO Rider |
$145.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
915355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| 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: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$186.22
|
| Rate for Payer: InnovAge PACE Commercial |
$260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| 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: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| 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 |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC SYMES ADDITION TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5618
|
| Hospital Charge Code |
905355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| 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: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$186.22
|
| Rate for Payer: InnovAge PACE Commercial |
$260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| 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 |
915355618
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| 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 |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
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 |
$143.44 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Adventist Health Commercial |
$179.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.24
|
| Rate for Payer: Blue Shield of California Commercial |
$338.57
|
| Rate for Payer: Blue Shield of California EPN |
$220.75
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| 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: Dignity Health Medi-Cal |
$372.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$194.65
|
| Rate for Payer: InnovAge PACE Commercial |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$306.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$306.60
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
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: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$338.57
|
| Rate for Payer: Blue Shield of California EPN |
$220.75
|
| Rate for Payer: Cash Price |
$240.90
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| 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 |
$284.70
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
|
HC SYMES ADD MEDIAL OPEN SOCKET
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT L5636
|
| Hospital Charge Code |
915355636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.44 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Adventist Health Commercial |
$179.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.24
|
| Rate for Payer: Blue Shield of California Commercial |
$338.57
|
| Rate for Payer: Blue Shield of California EPN |
$220.75
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| 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: Dignity Health Medi-Cal |
$372.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$194.65
|
| Rate for Payer: InnovAge PACE Commercial |
$219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$306.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$306.60
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC SYMES ADD MEDIAL OPEN SOCKET
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT L5636
|
| Hospital Charge Code |
915355636
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$338.57
|
| Rate for Payer: Blue Shield of California EPN |
$220.75
|
| Rate for Payer: Cash Price |
$240.90
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| 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 |
$284.70
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
|
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: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Blue Shield of California Commercial |
$671.74
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$477.95
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| 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 |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
|
|
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 |
$284.60 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Adventist Health Commercial |
$356.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.36
|
| Rate for Payer: Blue Shield of California Commercial |
$671.74
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| 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: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$391.83
|
| Rate for Payer: InnovAge PACE Commercial |
$434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| 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 System 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 |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| 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 |
915355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.80 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Adventist Health Commercial |
$173.80
|
| Rate for Payer: Blue Shield of California Commercial |
$671.74
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$477.95
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$331.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| 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 |
$564.85
|
| Rate for Payer: Prime Health Services Commercial |
$738.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
|
|
HC SYMES ADD POSTERIOR OPEN SOCKT
|
Facility
|
OP
|
$869.00
|
|
|
Service Code
|
CPT L5634
|
| Hospital Charge Code |
915355634
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$284.60 |
| Max. Negotiated Rate |
$782.10 |
| Rate for Payer: Adventist Health Commercial |
$356.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$651.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$510.36
|
| Rate for Payer: Blue Shield of California Commercial |
$671.74
|
| Rate for Payer: Blue Shield of California EPN |
$437.98
|
| Rate for Payer: Cash Price |
$477.95
|
| Rate for Payer: Cash Price |
$477.95
|
| 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: Dignity Health Medi-Cal |
$738.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$738.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$391.83
|
| Rate for Payer: InnovAge PACE Commercial |
$434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$579.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$537.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.30
|
| 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 System 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 |
$326.14
|
| Rate for Payer: United Healthcare All Other HMO |
$317.45
|
| Rate for Payer: United Healthcare HMO Rider |
$310.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$284.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$738.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$738.65
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$214.51 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Adventist Health Commercial |
$268.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$360.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.68
|
| Rate for Payer: Blue Shield of California Commercial |
$506.31
|
| Rate for Payer: Blue Shield of California EPN |
$330.12
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| 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: Dignity Health Medi-Cal |
$556.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$274.48
|
| Rate for Payer: InnovAge PACE Commercial |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.50
|
| 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 System 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 |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$556.75
|
| 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: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Blue Shield of California Commercial |
$506.31
|
| Rate for Payer: Blue Shield of California EPN |
$330.12
|
| Rate for Payer: Cash Price |
$360.25
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$249.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| 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 |
$425.75
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
|
|
HC SYMES ADD SKT INSRT-PELITE LIN
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT L5654
|
| Hospital Charge Code |
915355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.51 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Adventist Health Commercial |
$268.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$556.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$360.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.68
|
| Rate for Payer: Blue Shield of California Commercial |
$506.31
|
| Rate for Payer: Blue Shield of California EPN |
$330.12
|
| Rate for Payer: Cash Price |
$360.25
|
| Rate for Payer: Cash Price |
$360.25
|
| 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: Dignity Health Medi-Cal |
$556.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$556.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$274.48
|
| Rate for Payer: InnovAge PACE Commercial |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$458.50
|
| 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 System 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 |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$556.75
|
| 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 |
915355654
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$589.50 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Blue Shield of California Commercial |
$506.31
|
| Rate for Payer: Blue Shield of California EPN |
$330.12
|
| Rate for Payer: Cash Price |
$360.25
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$249.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| 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 |
$425.75
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.82
|
| Rate for Payer: United Healthcare All Other HMO |
$239.27
|
| Rate for Payer: United Healthcare HMO Rider |
$234.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$214.51
|
|
|
HC SYMES ADD SKT INST MULTI-DUROM
|
Facility
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
915355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.13 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Adventist Health Commercial |
$529.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$969.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.79
|
| Rate for Payer: Blue Shield of California Commercial |
$998.72
|
| Rate for Payer: Blue Shield of California EPN |
$651.17
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cash Price |
$710.60
|
| 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: Dignity Health Medi-Cal |
$1,098.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$593.21
|
| Rate for Payer: InnovAge PACE Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.40
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,098.20
|
| 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
|
OP
|
$1,292.00
|
|
|
Service Code
|
CPT L5661
|
| Hospital Charge Code |
905355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$423.13 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Adventist Health Commercial |
$529.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,098.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$710.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$969.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.79
|
| Rate for Payer: Blue Shield of California Commercial |
$998.72
|
| Rate for Payer: Blue Shield of California EPN |
$651.17
|
| Rate for Payer: Cash Price |
$710.60
|
| Rate for Payer: Cash Price |
$710.60
|
| 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: Dignity Health Medi-Cal |
$1,098.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,098.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$593.21
|
| Rate for Payer: InnovAge PACE Commercial |
$646.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$861.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$529.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.40
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,098.20
|
| 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 |
915355661
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$258.40 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Blue Shield of California Commercial |
$998.72
|
| Rate for Payer: Blue Shield of California EPN |
$651.17
|
| Rate for Payer: Cash Price |
$710.60
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| 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 |
$839.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
|
|
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: Adventist Health Commercial |
$258.40
|
| Rate for Payer: Blue Shield of California Commercial |
$998.72
|
| Rate for Payer: Blue Shield of California EPN |
$651.17
|
| Rate for Payer: Cash Price |
$710.60
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$492.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$799.75
|
| 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 |
$839.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,098.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$484.89
|
| Rate for Payer: United Healthcare All Other HMO |
$471.97
|
| Rate for Payer: United Healthcare HMO Rider |
$461.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.13
|
|
|
HC SYMES ANKLE W/O (SACH) FOOT
|
Facility
|
OP
|
$4,030.00
|
|
|
Service Code
|
CPT L5703
|
| Hospital Charge Code |
915355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,319.83 |
| Max. Negotiated Rate |
$3,627.00 |
| Rate for Payer: Adventist Health Commercial |
$1,652.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,425.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,216.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,022.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,366.82
|
| Rate for Payer: Blue Shield of California Commercial |
$3,115.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,031.12
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cash Price |
$2,216.50
|
| 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: Dignity Health Medi-Cal |
$3,425.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,425.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$2,656.37
|
| Rate for Payer: InnovAge PACE Commercial |
$2,015.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,688.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,934.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,652.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,821.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,821.00
|
| 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
|
| Rate for Payer: Riverside University Health System 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 |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,425.50
|
| 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 |
915355703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$806.00 |
| Max. Negotiated Rate |
$3,627.00 |
| Rate for Payer: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,115.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,031.12
|
| Rate for Payer: Cash Price |
$2,216.50
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$1,535.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| 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 |
$2,619.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
|
|
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: Adventist Health Commercial |
$806.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,115.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,031.12
|
| Rate for Payer: Cash Price |
$2,216.50
|
| 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 Senior |
$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: Kaiser Permanente of CA Medi-Cal |
$1,535.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,494.57
|
| 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 |
$2,619.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,425.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,512.46
|
| Rate for Payer: United Healthcare All Other HMO |
$1,472.16
|
| Rate for Payer: United Healthcare HMO Rider |
$1,440.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.83
|
|
