|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
915355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Blue Shield of California Commercial |
$68.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.84
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
905355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.44
|
| Rate for Payer: Blue Shield of California Commercial |
$68.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.84
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.50
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Riverside University Health System MISP |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
915355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.44
|
| Rate for Payer: Blue Shield of California Commercial |
$68.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.84
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$59.50
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Riverside University Health System MISP |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
905355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Blue Shield of California Commercial |
$68.17
|
| Rate for Payer: Blue Shield of California EPN |
$42.84
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.90
|
| Rate for Payer: United Healthcare All Other HMO |
$31.05
|
| Rate for Payer: United Healthcare HMO Rider |
$30.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.84
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
915355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.14 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$550.87
|
| Rate for Payer: Blue Shield of California Commercial |
$759.49
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$563.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Riverside University Health System MISP |
$378.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
905355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.14 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Adventist Health Commercial |
$388.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$710.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$550.87
|
| Rate for Payer: Blue Shield of California Commercial |
$759.49
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$804.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$804.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$563.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$622.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$662.90
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Riverside University Health System MISP |
$378.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
905355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$759.49
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.40
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$615.55
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
915355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: United Healthcare HMO Rider |
$338.46
|
| Rate for Payer: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$759.49
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Senior |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$601.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$558.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.40
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$615.55
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.41
|
| Rate for Payer: United Healthcare All Other HMO |
$345.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$310.14
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
915355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$364.40 |
| Max. Negotiated Rate |
$1,639.80 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,461.24
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,457.60
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,639.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,156.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,074.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.40
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: Networks By Design Commercial |
$1,184.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
915355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.71 |
| Max. Negotiated Rate |
$1,639.80 |
| Rate for Payer: Adventist Health Commercial |
$747.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,002.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,366.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,461.24
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,457.60
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,548.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,548.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,639.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$928.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,156.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,025.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,074.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,275.40
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: Riverside University Health System MISP |
$728.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,093.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,548.70
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
905355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$596.71 |
| Max. Negotiated Rate |
$1,639.80 |
| Rate for Payer: Adventist Health Commercial |
$747.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,002.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,366.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,059.86
|
| Rate for Payer: Blue Shield of California Commercial |
$1,461.24
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,457.60
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,548.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,548.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,639.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$928.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,156.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,025.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,074.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,275.40
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: Riverside University Health System MISP |
$728.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,093.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,548.70
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
905355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$364.40 |
| Max. Negotiated Rate |
$1,639.80 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,461.24
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,457.60
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,639.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,156.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,074.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.40
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: Networks By Design Commercial |
$1,184.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
|
|
HC BK ADDITION TEST SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
915355620
|
|
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 TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
915355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| 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 |
$186.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.71
|
| 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 TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
905355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.30 |
| 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 |
$186.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$330.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.71
|
| 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 TEST SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
905355620
|
|
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 TOTAL CONTACT SCKT
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
915355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.82 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Adventist Health Commercial |
$270.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$494.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.34
|
| Rate for Payer: Blue Shield of California Commercial |
$528.52
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$560.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$560.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$423.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$467.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$461.30
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Riverside University Health System MISP |
$263.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
905355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Adventist Health Commercial |
$131.80
|
| Rate for Payer: Blue Shield of California Commercial |
$528.52
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
905355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.82 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Adventist Health Commercial |
$270.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$494.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.34
|
| Rate for Payer: Blue Shield of California Commercial |
$528.52
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$560.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$560.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$423.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$467.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$461.30
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Riverside University Health System MISP |
$263.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
915355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: Adventist Health Commercial |
$131.80
|
| Rate for Payer: Blue Shield of California Commercial |
$528.52
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$418.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$428.35
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
915355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Adventist Health Commercial |
$99.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.77
|
| Rate for Payer: Blue Shield of California Commercial |
$194.08
|
| Rate for Payer: Blue Shield of California EPN |
$121.97
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$169.40
|
| Rate for Payer: Cigna of CA PPO |
$169.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$121.00
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Riverside University Health System MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.82
|
| Rate for Payer: United Healthcare All Other HMO |
$88.40
|
| Rate for Payer: United Healthcare HMO Rider |
$86.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
915355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$169.40
|
| Rate for Payer: Cigna of CA PPO |
$169.40
|
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Blue Shield of California Commercial |
$194.08
|
| Rate for Payer: Blue Shield of California EPN |
$121.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$153.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$142.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.82
|
| Rate for Payer: United Healthcare All Other HMO |
$88.40
|
| Rate for Payer: United Healthcare HMO Rider |
$86.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.25
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
905355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.32
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health System MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
905355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Blue Shield of California Commercial |
$170.02
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$134.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$125.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
915355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Adventist Health Commercial |
$419.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,681.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,677.60
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,467.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,887.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,331.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,237.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.40
|
| Rate for Payer: Multiplan Commercial |
$1,572.75
|
| Rate for Payer: Networks By Design Commercial |
$1,363.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
|
