|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
905355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.80
|
| Rate for Payer: Blue Shield of California Commercial |
$645.75
|
| Rate for Payer: Blue Shield of California EPN |
$425.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC BK ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
905355674
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.91
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$159.36
|
| Rate for Payer: Cigna of CA PPO |
$184.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC BK ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
905355674
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
|
|
HC BK ADD LATEX SUSP SLEEVE HVY D
|
Facility
|
OP
|
$187.00
|
|
| Hospital Charge Code |
905355675
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.84
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$119.68
|
| Rate for Payer: Cigna of CA PPO |
$138.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$130.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other HMO |
$93.50
|
| Rate for Payer: United Healthcare HMO Rider |
$93.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC BK ADD LATEX SUSP SLEEVE HVY D
|
Facility
|
IP
|
$187.00
|
|
| Hospital Charge Code |
905355675
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$158.95 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$115.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.88
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
905355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
915355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
915355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.22
|
| Rate for Payer: Blue Shield of California Commercial |
$169.74
|
| Rate for Payer: Blue Shield of California EPN |
$111.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
905355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.22
|
| Rate for Payer: Blue Shield of California Commercial |
$169.74
|
| Rate for Payer: Blue Shield of California EPN |
$111.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
915355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
915355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$404.28
|
| Rate for Payer: Blue Shield of California Commercial |
$515.12
|
| Rate for Payer: Blue Shield of California EPN |
$339.23
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
905355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$404.28
|
| Rate for Payer: Blue Shield of California Commercial |
$515.12
|
| Rate for Payer: Blue Shield of California EPN |
$339.23
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
905355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
915355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$938.40
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.23
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$419.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.16
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
905355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.52 |
| Max. Negotiated Rate |
$997.05 |
| Rate for Payer: Adventist Health Commercial |
$480.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.40
|
| Rate for Payer: Blue Shield of California Commercial |
$865.67
|
| Rate for Payer: Blue Shield of California EPN |
$570.08
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$658.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.10
|
| Rate for Payer: Multiplan Commercial |
$938.40
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.23
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$419.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
|
IP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
905355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$938.40
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.23
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$419.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.16
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
915355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.52 |
| Max. Negotiated Rate |
$997.05 |
| Rate for Payer: Adventist Health Commercial |
$480.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$679.40
|
| Rate for Payer: Blue Shield of California Commercial |
$865.67
|
| Rate for Payer: Blue Shield of California EPN |
$570.08
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$658.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.10
|
| Rate for Payer: Multiplan Commercial |
$938.40
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.23
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$419.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
915355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Adventist Health Commercial |
$250.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$519.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$458.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.89
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$296.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$519.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$519.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$519.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.70
|
| Rate for Payer: Multiplan Commercial |
$488.80
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other HMO |
$223.20
|
| Rate for Payer: United Healthcare HMO Rider |
$218.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$519.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$519.35
|
| Rate for Payer: Vantage Medical Group Senior |
$519.35
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
915355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Multiplan Commercial |
$488.80
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other HMO |
$223.20
|
| Rate for Payer: United Healthcare HMO Rider |
$218.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.10
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
905355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Multiplan Commercial |
$488.80
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other HMO |
$223.20
|
| Rate for Payer: United Healthcare HMO Rider |
$218.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.10
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
905355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Adventist Health Commercial |
$250.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$519.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$458.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$353.89
|
| Rate for Payer: Blue Shield of California Commercial |
$450.92
|
| Rate for Payer: Blue Shield of California EPN |
$296.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$519.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$519.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$519.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$218.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.70
|
| Rate for Payer: Multiplan Commercial |
$488.80
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other HMO |
$223.20
|
| Rate for Payer: United Healthcare HMO Rider |
$218.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$519.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$519.35
|
| Rate for Payer: Vantage Medical Group Senior |
$519.35
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
915355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: Adventist Health Commercial |
$142.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.98
|
| Rate for Payer: Blue Shield of California Commercial |
$256.09
|
| Rate for Payer: Blue Shield of California EPN |
$168.64
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.90
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
905355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
905355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$294.95 |
| Rate for Payer: Dignity Health Medi-Cal |
$294.95
|
| Rate for Payer: Adventist Health Commercial |
$142.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.98
|
| Rate for Payer: Blue Shield of California Commercial |
$256.09
|
| Rate for Payer: Blue Shield of California EPN |
$168.64
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.90
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
915355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.28
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
|
