|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$432.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,338.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
915355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$518.88 |
| Max. Negotiated Rate |
$1,837.70 |
| Rate for Payer: Adventist Health Commercial |
$886.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,189.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,050.73
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,837.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,837.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,048.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,185.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,338.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,513.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,513.40
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,837.70
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
915355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$432.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,338.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$518.88 |
| Max. Negotiated Rate |
$1,837.70 |
| Rate for Payer: Adventist Health Commercial |
$886.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,189.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,252.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.56
|
| Rate for Payer: Blue Shield of California EPN |
$1,050.73
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,837.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,837.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Senior |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,048.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,185.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,338.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$518.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,513.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,513.40
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$811.40
|
| Rate for Payer: United Healthcare All Other HMO |
$789.78
|
| Rate for Payer: United Healthcare HMO Rider |
$772.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,837.70
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
905355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
915355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$295.92 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Adventist Health Commercial |
$505.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.15
|
| Rate for Payer: Blue Shield of California Commercial |
$909.95
|
| Rate for Payer: Blue Shield of California EPN |
$599.24
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$396.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.10
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.05
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
915355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
905355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$295.92 |
| Max. Negotiated Rate |
$1,048.05 |
| Rate for Payer: Adventist Health Commercial |
$505.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.15
|
| Rate for Payer: Blue Shield of California Commercial |
$909.95
|
| Rate for Payer: Blue Shield of California EPN |
$599.24
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$396.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.10
|
| Rate for Payer: Multiplan Commercial |
$986.40
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.05
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
915355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$760.75 |
| Rate for Payer: Adventist Health Commercial |
$366.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$671.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.38
|
| Rate for Payer: Blue Shield of California Commercial |
$660.51
|
| Rate for Payer: Blue Shield of California EPN |
$434.97
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$760.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$760.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$326.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$626.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$626.50
|
| Rate for Payer: Multiplan Commercial |
$716.00
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$760.75
|
| Rate for Payer: Vantage Medical Group Senior |
$760.75
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
905355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$214.80 |
| Max. Negotiated Rate |
$760.75 |
| Rate for Payer: Adventist Health Commercial |
$366.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$671.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$518.38
|
| Rate for Payer: Blue Shield of California Commercial |
$660.51
|
| Rate for Payer: Blue Shield of California EPN |
$434.97
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$760.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$760.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$326.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$626.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$626.50
|
| Rate for Payer: Multiplan Commercial |
$716.00
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$760.75
|
| Rate for Payer: Vantage Medical Group Senior |
$760.75
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
905355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$179.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$716.00
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
915355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$179.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$554.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.80
|
| Rate for Payer: Multiplan Commercial |
$716.00
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
905355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$754.32 |
| Max. Negotiated Rate |
$2,671.55 |
| Rate for Payer: Adventist Health Commercial |
$1,288.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,728.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,357.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,820.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,527.50
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,671.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,671.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,179.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,096.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,945.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,200.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,200.10
|
| Rate for Payer: Multiplan Commercial |
$2,514.40
|
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,885.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,885.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,671.55
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
915355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Adventist Health Commercial |
$628.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,096.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,197.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,945.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.32
|
| Rate for Payer: Multiplan Commercial |
$2,514.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
905355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$628.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,096.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,197.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,945.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.32
|
| Rate for Payer: Multiplan Commercial |
$2,514.40
|
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
915355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$754.32 |
| Max. Negotiated Rate |
$2,671.55 |
| Rate for Payer: Adventist Health Commercial |
$1,288.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,728.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,357.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,820.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,527.50
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,671.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,671.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,179.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,096.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,945.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,200.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,200.10
|
| Rate for Payer: Multiplan Commercial |
$2,514.40
|
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,885.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,885.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,671.55
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
915355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Adventist Health Commercial |
$430.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$577.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$787.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.16
|
| Rate for Payer: Blue Shield of California Commercial |
$774.90
|
| Rate for Payer: Blue Shield of California EPN |
$510.30
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO |
$735.00
|
| Rate for Payer: Cigna of CA PPO |
$735.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$892.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$892.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$892.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$649.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$525.00
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.06
|
| Rate for Payer: United Healthcare All Other HMO |
$383.56
|
| Rate for Payer: United Healthcare HMO Rider |
$375.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$892.50
|
| Rate for Payer: Vantage Medical Group Senior |
$892.50
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
905355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.28 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$214.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$302.34
|
| Rate for Payer: Blue Shield of California Commercial |
$385.24
|
| Rate for Payer: Blue Shield of California EPN |
$253.69
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna of CA HMO |
$365.40
|
| Rate for Payer: Cigna of CA PPO |
$365.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$350.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$365.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$261.00
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.91
|
| Rate for Payer: United Healthcare All Other HMO |
$190.69
|
| Rate for Payer: United Healthcare HMO Rider |
$186.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
915355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO |
$735.00
|
| Rate for Payer: Cigna of CA PPO |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$700.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$649.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.00
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$525.00
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.06
|
| Rate for Payer: United Healthcare All Other HMO |
$383.56
|
| Rate for Payer: United Healthcare HMO Rider |
$375.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.88
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
905355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna of CA HMO |
$365.40
|
| Rate for Payer: Cigna of CA PPO |
$365.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.28
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: Networks By Design Commercial |
$261.00
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.91
|
| Rate for Payer: United Healthcare All Other HMO |
$190.69
|
| Rate for Payer: United Healthcare HMO Rider |
$186.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.96
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
905355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
905355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$582.24 |
| Max. Negotiated Rate |
$2,062.10 |
| Rate for Payer: Adventist Health Commercial |
$994.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,334.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,819.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,405.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,790.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.04
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,062.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,062.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,265.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,430.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,698.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,698.20
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,062.10
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
915355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$582.24 |
| Max. Negotiated Rate |
$2,062.10 |
| Rate for Payer: Adventist Health Commercial |
$994.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,334.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,819.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,405.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,790.39
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.04
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,062.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,062.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,265.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,430.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,698.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,698.20
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,062.10
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
915355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
|
|
HC AK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5460
|
| Hospital Charge Code |
905355460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.80
|
| Rate for Payer: Blue Shield of California Commercial |
$645.75
|
| Rate for Payer: Blue Shield of California EPN |
$425.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$276.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
