|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
915355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$350.67 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$458.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$838.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$656.60
|
| Rate for Payer: Blue Shield of California Commercial |
$864.21
|
| Rate for Payer: Blue Shield of California EPN |
$563.47
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.67
|
| Rate for Payer: InnovAge PACE Commercial |
$559.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$782.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$782.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Riverside University Health System MISP |
$447.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
905355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Blue Shield of California Commercial |
$864.21
|
| Rate for Payer: Blue Shield of California EPN |
$563.47
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
915355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Blue Shield of California Commercial |
$864.21
|
| Rate for Payer: Blue Shield of California EPN |
$563.47
|
| Rate for Payer: Cash Price |
$614.90
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Senior |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$692.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.59
|
| Rate for Payer: United Healthcare All Other HMO |
$408.41
|
| Rate for Payer: United Healthcare HMO Rider |
$399.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$366.14
|
|
|
HC AK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Adventist Health Commercial |
$249.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 WOOD SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
915355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: 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 WOOD SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Adventist Health Commercial |
$121.80
|
| Rate for Payer: Blue Shield of California Commercial |
$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 WOOD SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
915355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Adventist Health Commercial |
$249.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$456.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
915355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$1,713.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,623.84
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$4,712.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,264.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.80
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$5,569.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
OP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
915355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,310.48 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$3,513.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,712.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,032.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6,623.84
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$4,712.95
|
| Rate for Payer: Cash Price |
$4,712.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,283.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,283.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,310.48
|
| Rate for Payer: InnovAge PACE Commercial |
$4,284.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,513.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,998.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,998.30
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,427.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,283.65
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
OP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,310.48 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$3,513.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,712.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,426.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,032.57
|
| Rate for Payer: Blue Shield of California Commercial |
$6,623.84
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$4,712.95
|
| Rate for Payer: Cash Price |
$4,712.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,283.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,283.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,310.48
|
| Rate for Payer: InnovAge PACE Commercial |
$4,284.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,513.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,998.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,998.30
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,427.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,283.65
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$1,713.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,623.84
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$4,712.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,264.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,304.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.80
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$5,569.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
915355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Adventist Health Commercial |
$165.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.27
|
| Rate for Payer: Blue Shield of California Commercial |
$312.29
|
| Rate for Payer: Blue Shield of California EPN |
$203.62
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.54
|
| Rate for Payer: InnovAge PACE Commercial |
$202.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$202.00
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Riverside University Health System MISP |
$161.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$99.72
|
| Rate for Payer: Blue Shield of California EPN |
$65.02
|
| Rate for Payer: Cash Price |
$70.95
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.41
|
| Rate for Payer: United Healthcare All Other HMO |
$47.12
|
| Rate for Payer: United Healthcare HMO Rider |
$46.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.25
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
915355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Blue Shield of California Commercial |
$312.29
|
| Rate for Payer: Blue Shield of California EPN |
$203.62
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Adventist Health Commercial |
$52.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.76
|
| Rate for Payer: Blue Shield of California Commercial |
$99.72
|
| Rate for Payer: Blue Shield of California EPN |
$65.02
|
| Rate for Payer: Cash Price |
$70.95
|
| Rate for Payer: Cash Price |
$70.95
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.54
|
| Rate for Payer: InnovAge PACE Commercial |
$64.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$64.50
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.41
|
| Rate for Payer: United Healthcare All Other HMO |
$47.12
|
| Rate for Payer: United Healthcare HMO Rider |
$46.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Blue Shield of California Commercial |
$354.03
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$251.90
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$297.70
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Adventist Health Commercial |
$187.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.98
|
| Rate for Payer: Blue Shield of California Commercial |
$354.03
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$251.90
|
| Rate for Payer: Cash Price |
$251.90
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$389.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.49
|
| Rate for Payer: InnovAge PACE Commercial |
$229.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Riverside University Health System MISP |
$183.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
915355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Blue Shield of California Commercial |
$354.03
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$251.90
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$297.70
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
915355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Adventist Health Commercial |
$187.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.98
|
| Rate for Payer: Blue Shield of California Commercial |
$354.03
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$251.90
|
| Rate for Payer: Cash Price |
$251.90
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$389.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.49
|
| Rate for Payer: InnovAge PACE Commercial |
$229.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$283.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Riverside University Health System MISP |
$183.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$149.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.36
|
| Rate for Payer: Blue Shield of California Commercial |
$282.14
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.48
|
| Rate for Payer: InnovAge PACE Commercial |
$182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$255.50
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Riverside University Health System MISP |
$146.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Blue Shield of California Commercial |
$282.14
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
915355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$149.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.36
|
| Rate for Payer: Blue Shield of California Commercial |
$282.14
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.48
|
| Rate for Payer: InnovAge PACE Commercial |
$182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$255.50
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Riverside University Health System MISP |
$146.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
915355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Blue Shield of California Commercial |
$282.14
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
IP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
915355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,311.40 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,068.56
|
| Rate for Payer: Blue Shield of California EPN |
$3,304.73
|
| Rate for Payer: Cash Price |
$3,606.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,498.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,058.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.40
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Networks By Design Commercial |
$4,262.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
IP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
905355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,311.40 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,068.56
|
| Rate for Payer: Blue Shield of California EPN |
$3,304.73
|
| Rate for Payer: Cash Price |
$3,606.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,498.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,058.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.40
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Networks By Design Commercial |
$4,262.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
|
