|
HC AK MLD SKT OPN END ENDOSKELETL
|
Facility
|
IP
|
$12,870.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,574.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,574.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cigna of CA HMO |
$9,009.00
|
| Rate for Payer: Cigna of CA PPO |
$9,009.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,009.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,148.00
|
| Rate for Payer: Galaxy Health WC |
$10,939.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,172.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,593.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,088.80
|
| Rate for Payer: Multiplan Commercial |
$10,296.00
|
| Rate for Payer: Networks By Design Commercial |
$8,365.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,939.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,701.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4,599.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,214.93
|
|
|
HC AK MLD SKT OPN END ENDOSKELETL
|
Facility
|
IP
|
$12,870.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,574.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,574.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cigna of CA HMO |
$9,009.00
|
| Rate for Payer: Cigna of CA PPO |
$9,009.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,009.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,148.00
|
| Rate for Payer: Galaxy Health WC |
$10,939.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,722.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,172.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,593.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,088.80
|
| Rate for Payer: Multiplan Commercial |
$10,296.00
|
| Rate for Payer: Networks By Design Commercial |
$8,365.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,939.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,701.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4,599.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,214.93
|
|
|
HC AK MLD SKT OPN END ENDOSKELETL
|
Facility
|
OP
|
$12,870.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,088.80 |
| Max. Negotiated Rate |
$10,939.50 |
| Rate for Payer: Adventist Health Commercial |
$5,276.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,078.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,790.21
|
| Rate for Payer: Blue Shield of California Commercial |
$9,897.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6,525.09
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cigna of CA HMO |
$9,009.00
|
| Rate for Payer: Cigna of CA PPO |
$9,009.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,939.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,939.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,009.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,148.00
|
| Rate for Payer: Galaxy Health WC |
$10,939.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,722.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,723.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,172.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,593.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,088.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,009.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,009.00
|
| Rate for Payer: Multiplan Commercial |
$10,296.00
|
| Rate for Payer: Networks By Design Commercial |
$6,435.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,939.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,722.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,722.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,701.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4,599.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,214.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,939.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,939.50
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
IP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
915355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,376.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,376.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.16
|
| Rate for Payer: Multiplan Commercial |
$9,507.20
|
| Rate for Payer: Networks By Design Commercial |
$7,724.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
OP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
915355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,852.16 |
| Max. Negotiated Rate |
$10,101.40 |
| Rate for Payer: Adventist Health Commercial |
$4,872.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,536.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,913.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,193.39
|
| Rate for Payer: Blue Shield of California Commercial |
$9,138.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,025.19
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,101.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,101.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,051.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,581.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,318.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,318.80
|
| Rate for Payer: Multiplan Commercial |
$9,507.20
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,130.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,101.40
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
IP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,376.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,376.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.16
|
| Rate for Payer: Multiplan Commercial |
$9,507.20
|
| Rate for Payer: Networks By Design Commercial |
$7,724.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
OP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,852.16 |
| Max. Negotiated Rate |
$10,101.40 |
| Rate for Payer: Adventist Health Commercial |
$4,872.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,536.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,913.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,193.39
|
| Rate for Payer: Blue Shield of California Commercial |
$9,138.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,025.19
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,101.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,101.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,051.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,546.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,581.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,011.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,852.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,318.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,318.80
|
| Rate for Payer: Multiplan Commercial |
$9,507.20
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,130.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,101.40
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
915355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$3,399.15 |
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Adventist Health Commercial |
$1,639.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,199.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,999.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,420.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,075.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,027.49
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,399.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,399.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,109.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,386.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,799.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,799.30
|
| Rate for Payer: Multiplan Commercial |
$3,199.20
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,399.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,399.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,399.15
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$799.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.76
|
| Rate for Payer: Multiplan Commercial |
$3,199.20
|
| Rate for Payer: Networks By Design Commercial |
$2,599.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
915355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$799.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.76
|
| Rate for Payer: Multiplan Commercial |
$3,199.20
|
| Rate for Payer: Networks By Design Commercial |
$2,599.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$959.76 |
| Max. Negotiated Rate |
$3,399.15 |
| Rate for Payer: Adventist Health Commercial |
$1,639.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,199.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,999.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,420.59
|
| Rate for Payer: Blue Shield of California Commercial |
$3,075.23
|
| Rate for Payer: Blue Shield of California Commercial |
$2,027.49
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,399.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,399.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,109.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,539.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,386.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,359.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$959.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,799.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,799.30
|
| Rate for Payer: Multiplan Commercial |
$3,199.20
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,399.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,399.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,399.15
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
IP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
915355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,028.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.84
|
| Rate for Payer: Multiplan Commercial |
$4,112.80
|
| Rate for Payer: Networks By Design Commercial |
$3,341.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
OP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,233.84 |
| Max. Negotiated Rate |
$4,369.85 |
| Rate for Payer: Adventist Health Commercial |
$2,107.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,827.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,855.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,111.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3,953.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,606.49
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,369.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,107.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,383.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,598.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,598.70
|
| Rate for Payer: Multiplan Commercial |
$4,112.80
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,084.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.85
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
OP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
915355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,233.84 |
| Max. Negotiated Rate |
$4,369.85 |
| Rate for Payer: Adventist Health Commercial |
$2,107.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,827.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,855.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,111.85
|
| Rate for Payer: Blue Shield of California Commercial |
$3,953.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,606.49
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,369.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,107.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,383.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,598.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,598.70
|
| Rate for Payer: Multiplan Commercial |
$4,112.80
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,084.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.85
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
IP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,028.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,264.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,033.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,233.84
|
| Rate for Payer: Multiplan Commercial |
$4,112.80
|
| Rate for Payer: Networks By Design Commercial |
$3,341.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,101.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.68
|
| Rate for Payer: Multiplan Commercial |
$4,405.60
|
| Rate for Payer: Networks By Design Commercial |
$3,579.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
915355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,321.68 |
| Max. Negotiated Rate |
$4,680.95 |
| Rate for Payer: Adventist Health Commercial |
$2,257.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,028.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,130.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,333.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,234.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,792.05
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,680.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,680.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,507.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,836.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,854.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,854.90
|
| Rate for Payer: Multiplan Commercial |
$4,405.60
|
| Rate for Payer: Networks By Design Commercial |
$2,753.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,680.95
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
915355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,101.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.68
|
| Rate for Payer: Multiplan Commercial |
$4,405.60
|
| Rate for Payer: Networks By Design Commercial |
$3,579.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,321.68 |
| Max. Negotiated Rate |
$4,680.95 |
| Rate for Payer: Adventist Health Commercial |
$2,257.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,028.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,130.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,333.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,234.88
|
| Rate for Payer: Blue Shield of California Commercial |
$2,792.05
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,680.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,680.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,507.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,496.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,836.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,249.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,321.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,854.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,854.90
|
| Rate for Payer: Multiplan Commercial |
$4,405.60
|
| Rate for Payer: Networks By Design Commercial |
$2,753.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,680.95
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
915355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Adventist Health Commercial |
$1,090.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,463.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,045.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.62
|
| 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: Dignity Health Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,261.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,764.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,995.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,862.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,862.00
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$1,596.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,596.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,261.00
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| 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 |
$1,729.00
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| 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 |
$1,729.00
|
| 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
|
OP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.40 |
| Max. Negotiated Rate |
$2,261.00 |
| Rate for Payer: Adventist Health Commercial |
$1,090.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,463.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,610.10
|
| Rate for Payer: Blue Shield of California Commercial |
$2,045.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,348.62
|
| 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: Dignity Health Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,261.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,261.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,764.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,689.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,995.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,569.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$638.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,862.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,862.00
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$1,596.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,596.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,261.00
|
|
|
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 |
$3,580.95
|
| Rate for Payer: Blue Shield of California Commercial |
$4,549.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.41
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,961.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,756.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,218.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,490.44
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,183.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,756.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,490.44
|
| 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 |
$3,845.40
|
| 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
|
|
