|
HC ADDNL:OBSTACLES/STAIRS LE
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$8,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$9,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
|
|
HC ADDNL:OBSTACLES/STAIRS LE
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,912.50 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Adventist Health Commercial |
$6,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,809.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$8,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$7,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.00
|
|
|
HC ADDNL:OBSTACLES/STAIRS LE
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$8,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$9,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
|
|
HC ADDNL:OBSTACLES/STAIRS LE
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,912.50 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Adventist Health Commercial |
$6,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,809.50
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$8,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$7,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.00
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.35 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$467.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$669.52
|
| Rate for Payer: Blue Shield of California Commercial |
$881.22
|
| Rate for Payer: Blue Shield of California EPN |
$574.56
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Central Health Plan Commercial |
$912.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$731.86
|
| Rate for Payer: InnovAge PACE Commercial |
$570.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: Networks By Design Commercial |
$570.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Riverside University Health System MISP |
$456.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Blue Shield of California Commercial |
$881.22
|
| Rate for Payer: Blue Shield of California EPN |
$574.56
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Central Health Plan Commercial |
$912.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Blue Shield of California Commercial |
$881.22
|
| Rate for Payer: Blue Shield of California EPN |
$574.56
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Central Health Plan Commercial |
$912.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.35 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Adventist Health Commercial |
$467.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$669.52
|
| Rate for Payer: Blue Shield of California Commercial |
$881.22
|
| Rate for Payer: Blue Shield of California EPN |
$574.56
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Cash Price |
$627.00
|
| Rate for Payer: Central Health Plan Commercial |
$912.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$731.86
|
| Rate for Payer: InnovAge PACE Commercial |
$570.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: Networks By Design Commercial |
$570.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Riverside University Health System MISP |
$456.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.84
|
| Rate for Payer: United Healthcare All Other HMO |
$416.44
|
| Rate for Payer: United Healthcare HMO Rider |
$407.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
915355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.70 |
| Max. Negotiated Rate |
$1,125.90 |
| Rate for Payer: Adventist Health Commercial |
$512.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$938.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.71
|
| Rate for Payer: Blue Shield of California Commercial |
$967.02
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,063.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$420.47
|
| Rate for Payer: InnovAge PACE Commercial |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$774.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$625.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: Riverside University Health System MISP |
$500.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
905355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$409.70 |
| Max. Negotiated Rate |
$1,125.90 |
| Rate for Payer: Adventist Health Commercial |
$512.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$938.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.71
|
| Rate for Payer: Blue Shield of California Commercial |
$967.02
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,063.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$420.47
|
| Rate for Payer: InnovAge PACE Commercial |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$774.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$875.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$875.70
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$625.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: Riverside University Health System MISP |
$500.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
905355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$1,125.90 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Blue Shield of California Commercial |
$967.02
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$774.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.20
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$813.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
915355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$1,125.90 |
| Rate for Payer: Adventist Health Commercial |
$250.20
|
| Rate for Payer: Blue Shield of California Commercial |
$967.02
|
| Rate for Payer: Blue Shield of California EPN |
$630.50
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Senior |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$774.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.20
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$813.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$456.99
|
| Rate for Payer: United Healthcare HMO Rider |
$447.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.70
|
|
|
HC ADD PYLON W/INTGRTD ELECT FORC
|
Facility
|
IP
|
$9,277.00
|
|
| Hospital Charge Code |
905355989
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,855.40 |
| Max. Negotiated Rate |
$8,349.30 |
| Rate for Payer: Adventist Health Commercial |
$1,855.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,171.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,675.61
|
| Rate for Payer: Cash Price |
$5,102.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,421.60
|
| Rate for Payer: Cigna of CA HMO |
$6,493.90
|
| Rate for Payer: Cigna of CA PPO |
$6,493.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,710.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,710.80
|
| Rate for Payer: Galaxy Health WC |
$7,885.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,566.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,349.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,534.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,742.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,855.40
|
| Rate for Payer: Multiplan Commercial |
$6,957.75
|
| Rate for Payer: Networks By Design Commercial |
$6,030.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,885.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,481.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3,388.89
|
| Rate for Payer: United Healthcare HMO Rider |
$3,315.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,038.22
|
|
|
HC ADD PYLON W/INTGRTD ELECT FORC
|
Facility
|
OP
|
$9,277.00
|
|
| Hospital Charge Code |
905355989
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,038.22 |
| Max. Negotiated Rate |
$8,349.30 |
| Rate for Payer: Adventist Health Commercial |
$3,803.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,885.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,102.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,957.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,448.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,171.12
|
| Rate for Payer: Blue Shield of California EPN |
$4,675.61
|
| Rate for Payer: Cash Price |
$5,102.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,421.60
|
| Rate for Payer: Cigna of CA HMO |
$6,493.90
|
| Rate for Payer: Cigna of CA PPO |
$6,493.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,885.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,885.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,885.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,710.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,710.80
|
| Rate for Payer: Galaxy Health WC |
$7,885.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,566.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,349.30
|
| Rate for Payer: InnovAge PACE Commercial |
$4,638.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,534.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,742.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,803.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,493.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,493.90
|
| Rate for Payer: Multiplan Commercial |
$6,957.75
|
| Rate for Payer: Networks By Design Commercial |
$4,638.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,885.45
|
| Rate for Payer: Riverside University Health System MISP |
$3,710.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,566.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,566.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,481.66
|
| Rate for Payer: United Healthcare All Other HMO |
$3,388.89
|
| Rate for Payer: United Healthcare HMO Rider |
$3,315.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,038.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,885.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,885.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,885.45
|
|
|
HC ADD QCK CHNG DEV AK/BK
|
Facility
|
OP
|
$544.00
|
|
| Hospital Charge Code |
905355817
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Adventist Health Commercial |
$108.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$462.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$299.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$263.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.49
|
| Rate for Payer: Blue Shield of California Commercial |
$332.38
|
| Rate for Payer: Blue Shield of California EPN |
$217.06
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Central Health Plan Commercial |
$435.20
|
| Rate for Payer: Cigna of CA HMO |
$348.16
|
| Rate for Payer: Cigna of CA PPO |
$402.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$462.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$462.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$462.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: EPIC Health Plan Senior |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$489.60
|
| Rate for Payer: InnovAge PACE Commercial |
$272.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$362.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$336.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$380.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$380.80
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
| Rate for Payer: Riverside University Health System MISP |
$217.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$326.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$326.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.00
|
| Rate for Payer: United Healthcare All Other HMO |
$272.00
|
| Rate for Payer: United Healthcare HMO Rider |
$272.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$272.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$462.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$462.40
|
| Rate for Payer: Vantage Medical Group Senior |
$462.40
|
|
|
HC ADD QCK CHNG DEV AK/BK
|
Facility
|
IP
|
$544.00
|
|
| Hospital Charge Code |
905355817
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$489.60 |
| Rate for Payer: Adventist Health Commercial |
$108.80
|
| Rate for Payer: Cash Price |
$299.20
|
| Rate for Payer: Central Health Plan Commercial |
$435.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$217.60
|
| Rate for Payer: EPIC Health Plan Senior |
$217.60
|
| Rate for Payer: Galaxy Health WC |
$462.40
|
| Rate for Payer: Global Benefits Group Commercial |
$326.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$489.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$362.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$336.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.80
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Networks By Design Commercial |
$353.60
|
| Rate for Payer: Prime Health Services Commercial |
$462.40
|
|
|
HC ADD SHEATH AIR SEAL SUCTION
|
Facility
|
IP
|
$478.00
|
|
| Hospital Charge Code |
905358490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Adventist Health Commercial |
$95.60
|
| Rate for Payer: Blue Shield of California Commercial |
$369.49
|
| Rate for Payer: Blue Shield of California EPN |
$240.91
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.60
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$310.70
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
|
|
HC ADD SHEATH AIR SEAL SUCTION
|
Facility
|
OP
|
$478.00
|
|
| Hospital Charge Code |
905358490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.54 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Adventist Health Commercial |
$195.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$358.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.73
|
| Rate for Payer: Blue Shield of California Commercial |
$369.49
|
| Rate for Payer: Blue Shield of California EPN |
$240.91
|
| Rate for Payer: Cash Price |
$262.90
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: InnovAge PACE Commercial |
$239.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$334.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$334.60
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: Riverside University Health System MISP |
$191.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.39
|
| Rate for Payer: United Healthcare All Other HMO |
$174.61
|
| Rate for Payer: United Healthcare HMO Rider |
$170.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.30
|
| Rate for Payer: Vantage Medical Group Senior |
$406.30
|
|
|
HC ADD SYMES SKT INSERT SILICONE
|
Facility
|
OP
|
$2,438.00
|
|
|
Service Code
|
CPT L5660
|
| Hospital Charge Code |
905355660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$798.45 |
| Max. Negotiated Rate |
$2,194.20 |
| Rate for Payer: Adventist Health Commercial |
$999.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,072.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,340.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,828.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,431.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,884.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,228.75
|
| Rate for Payer: Cash Price |
$1,340.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,950.40
|
| Rate for Payer: Cigna of CA HMO |
$1,706.60
|
| Rate for Payer: Cigna of CA PPO |
$1,706.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,072.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,072.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,072.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$975.20
|
| Rate for Payer: Galaxy Health WC |
$2,072.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,194.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,626.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,509.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$999.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,706.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,706.60
|
| Rate for Payer: Multiplan Commercial |
$1,828.50
|
| Rate for Payer: Networks By Design Commercial |
$1,219.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,072.30
|
| Rate for Payer: Riverside University Health System MISP |
$975.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,462.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,462.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.98
|
| Rate for Payer: United Healthcare All Other HMO |
$890.60
|
| Rate for Payer: United Healthcare HMO Rider |
$871.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$798.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,072.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,072.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,072.30
|
|
|
HC ADD SYMES SKT INSERT SILICONE
|
Facility
|
IP
|
$2,438.00
|
|
|
Service Code
|
CPT L5660
|
| Hospital Charge Code |
905355660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$487.60 |
| Max. Negotiated Rate |
$2,194.20 |
| Rate for Payer: Adventist Health Commercial |
$487.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,884.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,228.75
|
| Rate for Payer: Cash Price |
$1,340.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,950.40
|
| Rate for Payer: Cigna of CA HMO |
$1,706.60
|
| Rate for Payer: Cigna of CA PPO |
$1,706.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$975.20
|
| Rate for Payer: EPIC Health Plan Senior |
$975.20
|
| Rate for Payer: Galaxy Health WC |
$2,072.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,462.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,194.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,626.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$928.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,509.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.60
|
| Rate for Payer: Multiplan Commercial |
$1,828.50
|
| Rate for Payer: Networks By Design Commercial |
$1,584.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,072.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$914.98
|
| Rate for Payer: United Healthcare All Other HMO |
$890.60
|
| Rate for Payer: United Healthcare HMO Rider |
$871.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$798.45
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
IP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.00 |
| Max. Negotiated Rate |
$2,821.50 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,423.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,580.04
|
| Rate for Payer: Cash Price |
$1,724.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,508.00
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,821.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.00
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
| Rate for Payer: Networks By Design Commercial |
$2,037.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
IP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.00 |
| Max. Negotiated Rate |
$2,821.50 |
| Rate for Payer: Adventist Health Commercial |
$627.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,423.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,580.04
|
| Rate for Payer: Cash Price |
$1,724.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,508.00
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,821.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,194.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$627.00
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
| Rate for Payer: Networks By Design Commercial |
$2,037.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$731.86 |
| Max. Negotiated Rate |
$2,821.50 |
| Rate for Payer: Adventist Health Commercial |
$1,285.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,724.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,351.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,841.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,423.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,580.04
|
| Rate for Payer: Cash Price |
$1,724.25
|
| Rate for Payer: Cash Price |
$1,724.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,508.00
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,664.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,664.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,821.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$731.86
|
| Rate for Payer: InnovAge PACE Commercial |
$1,567.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,194.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
| Rate for Payer: Networks By Design Commercial |
$1,567.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,254.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,664.75
|
|
|
HC ADD TO LE-BK/AK ICEROSS
|
Facility
|
OP
|
$3,135.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
915355667
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$731.86 |
| Max. Negotiated Rate |
$2,821.50 |
| Rate for Payer: Adventist Health Commercial |
$1,285.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,724.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,351.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,841.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,423.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,580.04
|
| Rate for Payer: Cash Price |
$1,724.25
|
| Rate for Payer: Cash Price |
$1,724.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,508.00
|
| Rate for Payer: Cigna of CA HMO |
$2,194.50
|
| Rate for Payer: Cigna of CA PPO |
$2,194.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,664.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,664.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,254.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,254.00
|
| Rate for Payer: Galaxy Health WC |
$2,664.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,881.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,821.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$731.86
|
| Rate for Payer: InnovAge PACE Commercial |
$1,567.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,940.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,285.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,194.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,194.50
|
| Rate for Payer: Multiplan Commercial |
$2,351.25
|
| Rate for Payer: Networks By Design Commercial |
$1,567.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,664.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,254.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,881.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,881.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,176.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,145.22
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,026.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,664.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,664.75
|
|
|
HC ADD TO LE ULTRAFLEX KNEE/ANKLE
|
Facility
|
OP
|
$657.00
|
|
| Hospital Charge Code |
905352860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.17 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Adventist Health Commercial |
$269.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.86
|
| Rate for Payer: Blue Shield of California Commercial |
$507.86
|
| Rate for Payer: Blue Shield of California EPN |
$331.13
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$558.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: InnovAge PACE Commercial |
$328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$459.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$459.90
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Riverside University Health System MISP |
$262.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.57
|
| Rate for Payer: United Healthcare All Other HMO |
$240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.45
|
| Rate for Payer: Vantage Medical Group Senior |
$558.45
|
|
