|
HC AK ADDITION SAFETY KNEE
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
915355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$676.29 |
| Max. Negotiated Rate |
$2,338.20 |
| Rate for Payer: Adventist Health Commercial |
$1,065.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,428.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,948.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,511.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,083.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,309.39
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,078.40
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,208.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,818.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,338.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$676.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,649.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$747.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,532.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,818.60
|
| Rate for Payer: Multiplan Commercial |
$1,948.50
|
| Rate for Payer: Networks By Design Commercial |
$1,299.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,039.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,558.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,558.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.03
|
| Rate for Payer: United Healthcare All Other HMO |
$949.05
|
| Rate for Payer: United Healthcare HMO Rider |
$928.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$850.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,208.30
|
|
|
HC AK ADDITION SAFETY KNEE
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
905355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$2,338.20 |
| Rate for Payer: Adventist Health Commercial |
$519.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,083.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,309.39
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,078.40
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,818.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,338.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,649.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,532.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.60
|
| Rate for Payer: Multiplan Commercial |
$1,948.50
|
| Rate for Payer: Networks By Design Commercial |
$1,688.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.03
|
| Rate for Payer: United Healthcare All Other HMO |
$949.05
|
| Rate for Payer: United Healthcare HMO Rider |
$928.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$850.85
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
915355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Blue Shield of California Commercial |
$244.61
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
905355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.42
|
| Rate for Payer: Blue Shield of California Commercial |
$244.61
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
905355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Blue Shield of California Commercial |
$244.61
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
915355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.52 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.42
|
| Rate for Payer: Blue Shield of California Commercial |
$244.61
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$193.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$93.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$179.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
905355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Adventist Health Commercial |
$176.00
|
| Rate for Payer: Blue Shield of California Commercial |
$705.76
|
| Rate for Payer: Blue Shield of California EPN |
$443.52
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$558.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$519.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$572.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
915355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.66 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Adventist Health Commercial |
$360.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$511.90
|
| Rate for Payer: Blue Shield of California Commercial |
$705.76
|
| Rate for Payer: Blue Shield of California EPN |
$443.52
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$748.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$139.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$558.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$519.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$616.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: Riverside University Health System MISP |
$352.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.00
|
| Rate for Payer: Vantage Medical Group Senior |
$748.00
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
915355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Adventist Health Commercial |
$176.00
|
| Rate for Payer: Blue Shield of California Commercial |
$705.76
|
| Rate for Payer: Blue Shield of California EPN |
$443.52
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$558.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$519.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$572.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
905355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.66 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Adventist Health Commercial |
$360.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$660.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$511.90
|
| Rate for Payer: Blue Shield of California Commercial |
$705.76
|
| Rate for Payer: Blue Shield of California EPN |
$443.52
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$748.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Senior |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$139.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$558.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$519.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$616.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: Riverside University Health System MISP |
$352.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.26
|
| Rate for Payer: United Healthcare All Other HMO |
$321.46
|
| Rate for Payer: United Healthcare HMO Rider |
$314.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.00
|
| Rate for Payer: Vantage Medical Group Senior |
$748.00
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
905355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
905355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.03
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$257.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
915355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.03
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$257.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
915355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
915355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.67 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Adventist Health Commercial |
$458.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.34
|
| Rate for Payer: Blue Shield of California Commercial |
$896.64
|
| Rate for Payer: Blue Shield of California EPN |
$563.47
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Riverside University Health System MISP |
$447.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
915355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Blue Shield of California Commercial |
$896.64
|
| Rate for Payer: Blue Shield of California EPN |
$563.47
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
905355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.67 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$458.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.34
|
| Rate for Payer: Blue Shield of California Commercial |
$896.64
|
| Rate for Payer: Blue Shield of California EPN |
$563.47
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$387.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Riverside University Health System MISP |
$447.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
905355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Blue Shield of California Commercial |
$896.64
|
| Rate for Payer: Blue Shield of California EPN |
$563.47
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$709.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$659.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
|
|
HC AK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
915355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Adventist Health Commercial |
$249.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.26
|
| Rate for Payer: Blue Shield of California Commercial |
$488.42
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$517.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$517.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$517.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$386.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$426.30
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: Riverside University Health System MISP |
$243.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$365.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$365.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$517.65
|
| Rate for Payer: Vantage Medical Group Senior |
$517.65
|
|
|
HC AK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Blue Shield of California Commercial |
$488.42
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$386.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.80
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$395.85
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
|
|
HC AK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Adventist Health Commercial |
$249.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$354.26
|
| Rate for Payer: Blue Shield of California Commercial |
$488.42
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$517.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$517.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$517.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$386.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$426.30
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: Riverside University Health System MISP |
$243.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$365.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$365.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$517.65
|
| Rate for Payer: Vantage Medical Group Senior |
$517.65
|
|
|
HC AK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
915355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: United Healthcare HMO Rider |
$217.66
|
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Blue Shield of California Commercial |
$488.42
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Senior |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$386.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.80
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$395.85
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.56
|
| Rate for Payer: United Healthcare All Other HMO |
$222.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.45
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
915355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$1,713.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,872.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,441.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,055.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.80
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$5,569.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
OP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,310.48 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$3,513.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,712.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.59
|
| Rate for Payer: Blue Shield of California Commercial |
$6,872.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,283.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,283.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,310.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,441.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,552.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,055.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,513.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,998.30
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,427.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,283.65
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$1,713.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,872.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,441.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,055.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.80
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$5,569.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
|
