|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
IP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
915355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$658.40 |
| Max. Negotiated Rate |
$2,962.80 |
| Rate for Payer: Adventist Health Commercial |
$658.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,544.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,659.17
|
| Rate for Payer: Cash Price |
$1,810.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,633.60
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,962.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,195.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,254.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,037.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.40
|
| Rate for Payer: Multiplan Commercial |
$2,469.00
|
| Rate for Payer: Networks By Design Commercial |
$2,139.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Blue Shield of California Commercial |
$664.01
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.80
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$558.35
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.49
|
| Rate for Payer: Blue Shield of California Commercial |
$664.01
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.10
|
| Rate for Payer: InnovAge PACE Commercial |
$429.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Riverside University Health System MISP |
$343.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
915355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Blue Shield of California Commercial |
$664.01
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.80
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$558.35
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
915355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$504.49
|
| Rate for Payer: Blue Shield of California Commercial |
$664.01
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Cash Price |
$472.45
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.10
|
| Rate for Payer: InnovAge PACE Commercial |
$429.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$531.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Riverside University Health System MISP |
$343.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
915355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$379.76 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$741.76
|
| Rate for Payer: Blue Shield of California Commercial |
$976.30
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$379.76
|
| Rate for Payer: InnovAge PACE Commercial |
$631.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health System MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$379.76 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$741.76
|
| Rate for Payer: Blue Shield of California Commercial |
$976.30
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$379.76
|
| Rate for Payer: InnovAge PACE Commercial |
$631.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health System MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
915355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Blue Shield of California Commercial |
$976.30
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Blue Shield of California Commercial |
$976.30
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$694.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
OP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
905355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,935.45 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Adventist Health Commercial |
$4,592.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,160.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,577.76
|
| Rate for Payer: Blue Shield of California Commercial |
$8,657.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,644.80
|
| Rate for Payer: Cash Price |
$6,160.00
|
| Rate for Payer: Cash Price |
$6,160.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,960.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,520.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,520.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,080.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,935.45
|
| Rate for Payer: InnovAge PACE Commercial |
$5,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,137.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,592.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,840.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,840.00
|
| Rate for Payer: Multiplan Commercial |
$8,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,480.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,520.00
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
IP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
915355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Adventist Health Commercial |
$2,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,657.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,644.80
|
| Rate for Payer: Cash Price |
$6,160.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,960.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,267.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,240.00
|
| Rate for Payer: Multiplan Commercial |
$8,400.00
|
| Rate for Payer: Networks By Design Commercial |
$7,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
IP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
905355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Adventist Health Commercial |
$2,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,657.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,644.80
|
| Rate for Payer: Cash Price |
$6,160.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,960.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,267.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,240.00
|
| Rate for Payer: Multiplan Commercial |
$8,400.00
|
| Rate for Payer: Networks By Design Commercial |
$7,280.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
OP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
915355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,935.45 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Adventist Health Commercial |
$4,592.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,160.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,577.76
|
| Rate for Payer: Blue Shield of California Commercial |
$8,657.60
|
| Rate for Payer: Blue Shield of California EPN |
$5,644.80
|
| Rate for Payer: Cash Price |
$6,160.00
|
| Rate for Payer: Cash Price |
$6,160.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,960.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,520.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,520.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,080.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,935.45
|
| Rate for Payer: InnovAge PACE Commercial |
$5,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,137.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,932.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,592.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,840.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,840.00
|
| Rate for Payer: Multiplan Commercial |
$8,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,480.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,520.00
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
IP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
915355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$7,669.80 |
| Rate for Payer: Adventist Health Commercial |
$1,704.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,587.51
|
| Rate for Payer: Blue Shield of California EPN |
$4,295.09
|
| Rate for Payer: Cash Price |
$4,687.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,817.60
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,669.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,246.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,704.40
|
| Rate for Payer: Multiplan Commercial |
$6,391.50
|
| Rate for Payer: Networks By Design Commercial |
$5,539.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
OP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
905355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,704.15 |
| Max. Negotiated Rate |
$7,669.80 |
| Rate for Payer: Adventist Health Commercial |
$3,494.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,687.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,004.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6,587.51
|
| Rate for Payer: Blue Shield of California EPN |
$4,295.09
|
| Rate for Payer: Cash Price |
$4,687.10
|
| Rate for Payer: Cash Price |
$4,687.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,817.60
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,243.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,669.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,704.15
|
| Rate for Payer: InnovAge PACE Commercial |
$4,261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,494.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,965.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,965.40
|
| Rate for Payer: Multiplan Commercial |
$6,391.50
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: Riverside University Health System MISP |
$3,408.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,113.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7,243.70
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
OP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
915355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,704.15 |
| Max. Negotiated Rate |
$7,669.80 |
| Rate for Payer: Adventist Health Commercial |
$3,494.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,687.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,004.97
|
| Rate for Payer: Blue Shield of California Commercial |
$6,587.51
|
| Rate for Payer: Blue Shield of California EPN |
$4,295.09
|
| Rate for Payer: Cash Price |
$4,687.10
|
| Rate for Payer: Cash Price |
$4,687.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,817.60
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,243.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,669.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,704.15
|
| Rate for Payer: InnovAge PACE Commercial |
$4,261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,494.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,965.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,965.40
|
| Rate for Payer: Multiplan Commercial |
$6,391.50
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: Riverside University Health System MISP |
$3,408.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,113.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7,243.70
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
IP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
905355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$7,669.80 |
| Rate for Payer: Adventist Health Commercial |
$1,704.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,587.51
|
| Rate for Payer: Blue Shield of California EPN |
$4,295.09
|
| Rate for Payer: Cash Price |
$4,687.10
|
| Rate for Payer: Central Health Plan Commercial |
$6,817.60
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,669.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,246.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,275.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,704.40
|
| Rate for Payer: Multiplan Commercial |
$6,391.50
|
| Rate for Payer: Networks By Design Commercial |
$5,539.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,198.31
|
| Rate for Payer: United Healthcare All Other HMO |
$3,113.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3,045.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,790.95
|
|
|
HC AK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
915355642
|
|
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 |
$357.67
|
| Rate for Payer: Blue Shield of California Commercial |
$470.76
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$334.95
|
| Rate for Payer: Cash Price |
$334.95
|
| 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: 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: InnovAge PACE Commercial |
$304.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$426.30
|
| Rate for Payer: Molina Healthcare of CA 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 LEATHER SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
905355642
|
|
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 |
$470.76
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$334.95
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| 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 LEATHER SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
905355642
|
|
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 |
$357.67
|
| Rate for Payer: Blue Shield of California Commercial |
$470.76
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$334.95
|
| Rate for Payer: Cash Price |
$334.95
|
| 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: 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: InnovAge PACE Commercial |
$304.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$426.30
|
| Rate for Payer: Molina Healthcare of CA 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 LEATHER SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
915355642
|
|
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 |
$470.76
|
| Rate for Payer: Blue Shield of California EPN |
$306.94
|
| Rate for Payer: Cash Price |
$334.95
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$376.97
|
| 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 MULTIPLEX SYSTEM
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
905355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.60 |
| Max. Negotiated Rate |
$3,278.70 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,816.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,836.07
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,914.40
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,278.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.60
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
| Rate for Payer: Networks By Design Commercial |
$2,367.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
915355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.60 |
| Max. Negotiated Rate |
$3,278.70 |
| Rate for Payer: Adventist Health Commercial |
$728.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,816.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,836.07
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,914.40
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,278.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.60
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
| Rate for Payer: Networks By Design Commercial |
$2,367.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
915355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,086.71 |
| Max. Negotiated Rate |
$3,278.70 |
| Rate for Payer: Adventist Health Commercial |
$1,493.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,732.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,139.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,816.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,836.07
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,914.40
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,096.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,096.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,278.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,086.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,821.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,200.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,550.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,550.10
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,457.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,096.55
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
905355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,086.71 |
| Max. Negotiated Rate |
$3,278.70 |
| Rate for Payer: Adventist Health Commercial |
$1,493.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,732.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,139.53
|
| Rate for Payer: Blue Shield of California Commercial |
$2,816.04
|
| Rate for Payer: Blue Shield of California EPN |
$1,836.07
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Cash Price |
$2,003.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,914.40
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,096.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,096.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,278.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,086.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,821.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,200.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,255.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,550.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,550.10
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,457.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.79
|
| Rate for Payer: United Healthcare HMO Rider |
$1,302.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,096.55
|
|
