|
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: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Blue Shield of California Commercial |
$65.70
|
| Rate for Payer: Blue Shield of California EPN |
$42.84
|
| Rate for Payer: Cash Price |
$46.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| 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 |
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 |
$556.17
|
| Rate for Payer: Blue Shield of California Commercial |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Cash Price |
$520.85
|
| 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: 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: InnovAge PACE Commercial |
$473.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA 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 |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| 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: Adventist Health Commercial |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| 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
|
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 |
$556.17
|
| Rate for Payer: Blue Shield of California Commercial |
$732.03
|
| Rate for Payer: Blue Shield of California EPN |
$477.29
|
| Rate for Payer: Cash Price |
$520.85
|
| Rate for Payer: Cash Price |
$520.85
|
| 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: 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: InnovAge PACE Commercial |
$473.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$586.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$662.90
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$1,070.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,408.41
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$1,002.10
|
| Rate for Payer: Cash Price |
$1,002.10
|
| 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: 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: InnovAge PACE Commercial |
$911.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,275.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,070.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,408.41
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$1,002.10
|
| Rate for Payer: Cash Price |
$1,002.10
|
| 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: 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: InnovAge PACE Commercial |
$911.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,275.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,408.41
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$1,002.10
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| 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
|
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 |
$1,408.41
|
| Rate for Payer: Blue Shield of California EPN |
$918.29
|
| Rate for Payer: Cash Price |
$1,002.10
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| 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
|
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 |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| 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: 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: InnovAge PACE Commercial |
$260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| 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
|
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 |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| 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 |
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 |
$305.40
|
| Rate for Payer: Blue Shield of California Commercial |
$401.96
|
| Rate for Payer: Blue Shield of California EPN |
$262.08
|
| Rate for Payer: Cash Price |
$286.00
|
| Rate for Payer: Cash Price |
$286.00
|
| 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: 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: InnovAge PACE Commercial |
$260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA 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 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: Adventist Health Commercial |
$131.80
|
| Rate for Payer: Blue Shield of California Commercial |
$509.41
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Cash Price |
$362.45
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| 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 |
$387.03
|
| Rate for Payer: Blue Shield of California Commercial |
$509.41
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Cash Price |
$362.45
|
| Rate for Payer: Cash Price |
$362.45
|
| 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: 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: InnovAge PACE Commercial |
$329.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$461.30
|
| Rate for Payer: Molina Healthcare of CA 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 |
$509.41
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Cash Price |
$362.45
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| 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 |
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 |
$387.03
|
| Rate for Payer: Blue Shield of California Commercial |
$509.41
|
| Rate for Payer: Blue Shield of California EPN |
$332.14
|
| Rate for Payer: Cash Price |
$362.45
|
| Rate for Payer: Cash Price |
$362.45
|
| 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: 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: InnovAge PACE Commercial |
$329.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$461.30
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| 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 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 |
$142.13
|
| Rate for Payer: Blue Shield of California Commercial |
$187.07
|
| Rate for Payer: Blue Shield of California EPN |
$121.97
|
| Rate for Payer: Cash Price |
$133.10
|
| Rate for Payer: Cash Price |
$133.10
|
| 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: 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: InnovAge PACE Commercial |
$121.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.40
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$124.51
|
| Rate for Payer: Blue Shield of California Commercial |
$163.88
|
| Rate for Payer: Blue Shield of California EPN |
$106.85
|
| Rate for Payer: Cash Price |
$116.60
|
| Rate for Payer: Cash Price |
$116.60
|
| 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: 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: InnovAge PACE Commercial |
$106.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA 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
|
$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: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Blue Shield of California Commercial |
$187.07
|
| Rate for Payer: Blue Shield of California EPN |
$121.97
|
| Rate for Payer: Cash Price |
$133.10
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| 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 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 |
$1,620.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$1,153.35
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| 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
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
905355639
|
|
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 |
$1,620.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$1,153.35
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| 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
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
905355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$686.77 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Adventist Health Commercial |
$859.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,153.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,572.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,231.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,620.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$1,153.35
|
| Rate for Payer: Cash Price |
$1,153.35
|
| 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: Dignity Health Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,782.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,782.45
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$1,649.65
|
| Rate for Payer: InnovAge PACE Commercial |
$1,048.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,822.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,467.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,467.90
|
| Rate for Payer: Multiplan Commercial |
$1,572.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: Riverside University Health System MISP |
$838.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,258.20
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,782.45
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
915355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$686.77 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Adventist Health Commercial |
$859.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,153.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,572.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,231.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1,620.98
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$1,153.35
|
| Rate for Payer: Cash Price |
$1,153.35
|
| 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: Dignity Health Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,782.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,782.45
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$1,649.65
|
| Rate for Payer: InnovAge PACE Commercial |
$1,048.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,822.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,467.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,467.90
|
| Rate for Payer: Multiplan Commercial |
$1,572.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: Riverside University Health System MISP |
$838.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,258.20
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,782.45
|
|
