|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
OP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
915355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,175.95 |
| Max. Negotiated Rate |
$7,221.60 |
| Rate for Payer: Adventist Health Commercial |
$3,289.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,413.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,018.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,667.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6,435.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,044.10
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,419.20
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,820.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,820.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,175.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,299.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,289.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,616.80
|
| Rate for Payer: Multiplan Commercial |
$6,018.00
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: Riverside University Health System MISP |
$3,209.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,814.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Senior |
$6,820.40
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
IP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
915355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,604.80 |
| Max. Negotiated Rate |
$7,221.60 |
| Rate for Payer: Adventist Health Commercial |
$1,604.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,435.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,044.10
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,419.20
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,221.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.80
|
| Rate for Payer: Multiplan Commercial |
$6,018.00
|
| Rate for Payer: Networks By Design Commercial |
$5,215.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
OP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
905355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,175.95 |
| Max. Negotiated Rate |
$7,221.60 |
| Rate for Payer: Adventist Health Commercial |
$3,289.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,413.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,018.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,667.56
|
| Rate for Payer: Blue Shield of California Commercial |
$6,435.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,044.10
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,419.20
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,820.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,820.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,175.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,299.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,289.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,616.80
|
| Rate for Payer: Multiplan Commercial |
$6,018.00
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: Riverside University Health System MISP |
$3,209.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,814.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Senior |
$6,820.40
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
IP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
905355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,604.80 |
| Max. Negotiated Rate |
$7,221.60 |
| Rate for Payer: Adventist Health Commercial |
$1,604.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,435.25
|
| Rate for Payer: Blue Shield of California EPN |
$4,044.10
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,419.20
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,221.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,095.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,734.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.80
|
| Rate for Payer: Multiplan Commercial |
$6,018.00
|
| Rate for Payer: Networks By Design Commercial |
$5,215.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,011.41
|
| Rate for Payer: United Healthcare All Other HMO |
$2,931.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2,867.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,627.86
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
905355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.52
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$2,034.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
915355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Adventist Health Commercial |
$626.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.52
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$2,034.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
915355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$661.36 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Adventist Health Commercial |
$1,283.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,347.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,820.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.52
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,660.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,660.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$661.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,283.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,191.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
905355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$661.36 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,283.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,347.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,820.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,510.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,577.52
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,660.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,660.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$661.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,987.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$730.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,846.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,283.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,191.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.69
|
| Rate for Payer: United Healthcare All Other HMO |
$1,143.39
|
| Rate for Payer: United Healthcare HMO Rider |
$1,118.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,025.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
905355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.89 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.36
|
| Rate for Payer: Blue Shield of California Commercial |
$518.89
|
| Rate for Payer: Blue Shield of California EPN |
$326.09
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Central Health Plan Commercial |
$517.60
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$582.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$485.25
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Riverside University Health System MISP |
$258.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
905355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Blue Shield of California Commercial |
$518.89
|
| Rate for Payer: Blue Shield of California EPN |
$326.09
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Central Health Plan Commercial |
$517.60
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$582.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.40
|
| Rate for Payer: Multiplan Commercial |
$485.25
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
915355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Adventist Health Commercial |
$129.40
|
| Rate for Payer: Blue Shield of California Commercial |
$518.89
|
| Rate for Payer: Blue Shield of California EPN |
$326.09
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Central Health Plan Commercial |
$517.60
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$582.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.40
|
| Rate for Payer: Multiplan Commercial |
$485.25
|
| Rate for Payer: Networks By Design Commercial |
$420.55
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
915355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.89 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Adventist Health Commercial |
$265.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$485.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.36
|
| Rate for Payer: Blue Shield of California Commercial |
$518.89
|
| Rate for Payer: Blue Shield of California EPN |
$326.09
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Central Health Plan Commercial |
$517.60
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$549.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Senior |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$582.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$452.90
|
| Rate for Payer: Multiplan Commercial |
$485.25
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Riverside University Health System MISP |
$258.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$242.82
|
| Rate for Payer: United Healthcare All Other HMO |
$236.35
|
| Rate for Payer: United Healthcare HMO Rider |
$231.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC AK ADD SKT INSERT SILICONE GEL
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT L5664
|
| Hospital Charge Code |
905355664
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Adventist Health Commercial |
$280.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,122.80
|
| Rate for Payer: Blue Shield of California EPN |
$705.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.00
|
| Rate for Payer: Cigna of CA HMO |
$980.00
|
| Rate for Payer: Cigna of CA PPO |
$980.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$980.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$560.00
|
| Rate for Payer: Galaxy Health WC |
$1,190.00
|
| Rate for Payer: Global Benefits Group Commercial |
$840.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,260.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$889.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$1,050.00
|
| Rate for Payer: Networks By Design Commercial |
$910.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$525.42
|
| Rate for Payer: United Healthcare All Other HMO |
$511.42
|
| Rate for Payer: United Healthcare HMO Rider |
$500.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
|
|
HC AK ADD SKT INSERT SILICONE GEL
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT L5664
|
| Hospital Charge Code |
905355664
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$458.50 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Adventist Health Commercial |
$574.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,190.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$770.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,050.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$814.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,122.80
|
| Rate for Payer: Blue Shield of California EPN |
$705.60
|
| Rate for Payer: Cash Price |
$630.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.00
|
| Rate for Payer: Cigna of CA HMO |
$980.00
|
| Rate for Payer: Cigna of CA PPO |
$980.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,190.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,190.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,190.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$980.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$560.00
|
| Rate for Payer: Galaxy Health WC |
$1,190.00
|
| Rate for Payer: Global Benefits Group Commercial |
$840.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,260.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$889.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$508.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$574.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$980.00
|
| Rate for Payer: Multiplan Commercial |
$1,050.00
|
| Rate for Payer: Networks By Design Commercial |
$700.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.00
|
| Rate for Payer: Riverside University Health System MISP |
$560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$840.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$525.42
|
| Rate for Payer: United Healthcare All Other HMO |
$511.42
|
| Rate for Payer: United Healthcare HMO Rider |
$500.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,190.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,190.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,190.00
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
915355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,138.42 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,010.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,138.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,362.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,758.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
905355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,138.42 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,010.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,138.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,362.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,758.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
915355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.00
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$4,481.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
905355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.00
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$4,481.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
915355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Adventist Health Commercial |
$432.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,733.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.65
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Adventist Health Commercial |
$432.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,733.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.65
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$708.05 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Adventist Health Commercial |
$886.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,189.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,257.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,733.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.65
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,837.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,837.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,073.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,185.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$886.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,513.40
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Riverside University Health System MISP |
$864.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,837.70
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
915355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$708.05 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Adventist Health Commercial |
$886.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,189.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,257.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,733.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.65
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,837.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,837.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,073.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,372.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,185.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$886.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,513.40
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Riverside University Health System MISP |
$864.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,837.70
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
915355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$403.81 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$505.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.24
|
| Rate for Payer: Blue Shield of California Commercial |
$988.87
|
| Rate for Payer: Blue Shield of California EPN |
$621.43
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$406.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$448.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$727.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.10
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Riverside University Health System MISP |
$493.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.05
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
905355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$403.81 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$505.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.24
|
| Rate for Payer: Blue Shield of California Commercial |
$988.87
|
| Rate for Payer: Blue Shield of California EPN |
$621.43
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$406.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$448.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$727.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.10
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Riverside University Health System MISP |
$493.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.05
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
905355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Blue Shield of California Commercial |
$988.87
|
| Rate for Payer: Blue Shield of California EPN |
$621.43
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$727.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
|
