|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
915355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$508.28 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,319.20
|
| Rate for Payer: Adventist Health Commercial |
$636.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,164.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$902.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,244.70
|
| Rate for Payer: Blue Shield of California EPN |
$782.21
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,319.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,396.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$734.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$985.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$811.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$915.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,086.40
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: Riverside University Health System MISP |
$620.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,319.20
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
905355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.81 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$551.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$740.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.49
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,144.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,144.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$599.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$662.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$942.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Riverside University Health System MISP |
$538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.10
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
915355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.81 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$551.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$740.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.49
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,144.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,144.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$599.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$662.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$942.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Riverside University Health System MISP |
$538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.10
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
905355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.49
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$874.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
915355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$874.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
915355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.52 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.48
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
905355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
905355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.52 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.48
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$187.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
915355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$417.04
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$338.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC BK ADDITION AIR CUSSION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
915355646
|
|
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 |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$568.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| 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 BK ADDITION AIR CUSSION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
905355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.23 |
| 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 |
$734.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$356.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 BK ADDITION AIR CUSSION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
915355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$356.23 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| 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 |
$734.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$356.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| 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 BK ADDITION AIR CUSSION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
905355646
|
|
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 |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$568.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| 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 BK ADDITION BACK CHECK
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
905355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Blue Shield of California Commercial |
$102.66
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
915355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Blue Shield of California Commercial |
$102.66
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
905355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.46
|
| Rate for Payer: Blue Shield of California Commercial |
$102.66
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Riverside University Health System MISP |
$51.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
915355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.46
|
| Rate for Payer: Blue Shield of California Commercial |
$102.66
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$75.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Riverside University Health System MISP |
$51.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
915355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.26 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.03
|
| Rate for Payer: Blue Shield of California Commercial |
$147.57
|
| Rate for Payer: Blue Shield of California EPN |
$92.74
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
915355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California Commercial |
$147.57
|
| Rate for Payer: Blue Shield of California EPN |
$92.74
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
905355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.26 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$75.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.03
|
| Rate for Payer: Blue Shield of California Commercial |
$147.57
|
| Rate for Payer: Blue Shield of California EPN |
$92.74
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health System MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
905355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Blue Shield of California Commercial |
$147.57
|
| Rate for Payer: Blue Shield of California EPN |
$92.74
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.06
|
| Rate for Payer: United Healthcare All Other HMO |
$67.22
|
| Rate for Payer: United Healthcare HMO Rider |
$65.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.26
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
915355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.73
|
| Rate for Payer: Blue Shield of California Commercial |
$90.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.95
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.10
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Riverside University Health System MISP |
$45.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
915355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Blue Shield of California Commercial |
$90.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.95
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
905355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Adventist Health Commercial |
$22.60
|
| Rate for Payer: Blue Shield of California Commercial |
$90.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.95
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$73.45
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
905355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Adventist Health Commercial |
$46.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.73
|
| Rate for Payer: Blue Shield of California Commercial |
$90.63
|
| Rate for Payer: Blue Shield of California EPN |
$56.95
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Senior |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$56.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.10
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Riverside University Health System MISP |
$45.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.41
|
| Rate for Payer: United Healthcare All Other HMO |
$41.28
|
| Rate for Payer: United Healthcare HMO Rider |
$40.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
