|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
915355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,013.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,646.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,013.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,646.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Multiplan Commercial |
$2,128.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
915355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,419.84 |
| Max. Negotiated Rate |
$5,028.60 |
| Rate for Payer: Adventist Health Commercial |
$2,425.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,253.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,426.55
|
| Rate for Payer: Blue Shield of California Commercial |
$4,366.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.18
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,028.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,028.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,961.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,141.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,028.60
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
915355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,183.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,254.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.84
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,183.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,254.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.84
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,419.84 |
| Max. Negotiated Rate |
$5,028.60 |
| Rate for Payer: Adventist Health Commercial |
$2,425.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,253.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,426.55
|
| Rate for Payer: Blue Shield of California Commercial |
$4,366.01
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.18
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,028.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,028.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,961.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,141.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,732.80
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,028.60
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,806.96 |
| Max. Negotiated Rate |
$6,399.65 |
| Rate for Payer: Adventist Health Commercial |
$3,086.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,646.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,360.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,556.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,659.09
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,399.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,723.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,806.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,270.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,270.30
|
| Rate for Payer: Multiplan Commercial |
$6,023.20
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,505.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,806.96
|
| Rate for Payer: Multiplan Commercial |
$6,023.20
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,505.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,806.96
|
| Rate for Payer: Multiplan Commercial |
$6,023.20
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,806.96 |
| Max. Negotiated Rate |
$6,399.65 |
| Rate for Payer: Adventist Health Commercial |
$3,086.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,646.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,360.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,556.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,659.09
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,399.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,723.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,806.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,270.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,270.30
|
| Rate for Payer: Multiplan Commercial |
$6,023.20
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
915355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$705.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.36
|
| Rate for Payer: Blue Shield of California EPN |
$835.92
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$748.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$846.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,204.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$1,462.00 |
| Rate for Payer: Adventist Health Commercial |
$705.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$996.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,269.36
|
| Rate for Payer: Blue Shield of California EPN |
$835.92
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$748.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$846.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,204.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
915355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,376.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
915355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.12 |
| Max. Negotiated Rate |
$6,619.80 |
| Rate for Payer: Adventist Health Commercial |
$3,193.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,283.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,841.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,510.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5,747.54
|
| Rate for Payer: Blue Shield of California EPN |
$3,784.97
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,619.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,619.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,389.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,833.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,451.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,451.60
|
| Rate for Payer: Multiplan Commercial |
$6,230.40
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,672.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,619.80
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
915355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,557.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,967.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.12
|
| Rate for Payer: Multiplan Commercial |
$6,230.40
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,557.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,967.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.12
|
| Rate for Payer: Multiplan Commercial |
$6,230.40
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,869.12 |
| Max. Negotiated Rate |
$6,619.80 |
| Rate for Payer: Adventist Health Commercial |
$3,193.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,283.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,841.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,510.81
|
| Rate for Payer: Blue Shield of California Commercial |
$5,747.54
|
| Rate for Payer: Blue Shield of California EPN |
$3,784.97
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cash Price |
$3,504.60
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,619.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,619.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,389.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,833.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,869.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,451.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,451.60
|
| Rate for Payer: Multiplan Commercial |
$6,230.40
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,672.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,619.80
|
|
|
HC AK STUBBIES
|
Facility
|
OP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
915355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,290.96 |
| Max. Negotiated Rate |
$4,572.15 |
| Rate for Payer: Adventist Health Commercial |
$2,205.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,958.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,034.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,115.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,969.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,614.19
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,572.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,666.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,015.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,765.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,765.30
|
| Rate for Payer: Multiplan Commercial |
$4,303.20
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,572.15
|
|
|
HC AK STUBBIES
|
Facility
|
IP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.96
|
| Rate for Payer: Multiplan Commercial |
$4,303.20
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
|
|
HC AK STUBBIES
|
Facility
|
IP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
915355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,075.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.96
|
| Rate for Payer: Multiplan Commercial |
$4,303.20
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
|
|
HC AK STUBBIES
|
Facility
|
OP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,290.96 |
| Max. Negotiated Rate |
$4,572.15 |
| Rate for Payer: Adventist Health Commercial |
$2,205.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,958.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,034.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,115.52
|
| Rate for Payer: Blue Shield of California Commercial |
$3,969.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,614.19
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cash Price |
$2,420.55
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,572.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,666.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,015.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,290.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,765.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,765.30
|
| Rate for Payer: Multiplan Commercial |
$4,303.20
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,572.15
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
915355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,972.08
|
| Rate for Payer: Multiplan Commercial |
$6,573.60
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
IP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
905355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,643.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,643.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,972.08
|
| Rate for Payer: Multiplan Commercial |
$6,573.60
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
|
|
HC AK STUBBIES W/ ARTICULTD ANKLE
|
Facility
|
OP
|
$8,217.00
|
|
|
Service Code
|
CPT L5220
|
| Hospital Charge Code |
915355220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,972.08 |
| Max. Negotiated Rate |
$6,984.45 |
| Rate for Payer: Adventist Health Commercial |
$3,368.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,519.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,162.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,759.29
|
| Rate for Payer: Blue Shield of California Commercial |
$6,064.15
|
| Rate for Payer: Blue Shield of California EPN |
$3,993.46
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cash Price |
$3,697.65
|
| Rate for Payer: Cigna of CA HMO |
$5,751.90
|
| Rate for Payer: Cigna of CA PPO |
$5,751.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,984.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,984.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,286.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,286.80
|
| Rate for Payer: Galaxy Health WC |
$6,984.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,930.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,199.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,480.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,618.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,086.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,972.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,751.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,751.90
|
| Rate for Payer: Multiplan Commercial |
$6,573.60
|
| Rate for Payer: Networks By Design Commercial |
$4,108.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,984.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,930.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,930.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,083.84
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,936.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,691.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,984.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,984.45
|
|
