|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
915355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
915355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$603.50 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.23
|
| Rate for Payer: Blue Shield of California Commercial |
$523.98
|
| Rate for Payer: Blue Shield of California EPN |
$345.06
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
905355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
905355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$603.50 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.23
|
| Rate for Payer: Blue Shield of California Commercial |
$523.98
|
| Rate for Payer: Blue Shield of California EPN |
$345.06
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$568.00
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
915355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.72
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
915355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.72 |
| Max. Negotiated Rate |
$980.05 |
| Rate for Payer: Adventist Health Commercial |
$472.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$634.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.82
|
| Rate for Payer: Blue Shield of California Commercial |
$850.91
|
| Rate for Payer: Blue Shield of California EPN |
$560.36
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$980.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$980.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$980.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$418.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$807.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$807.10
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$980.05
|
| Rate for Payer: Vantage Medical Group Senior |
$980.05
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
905355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.72
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
905355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$276.72 |
| Max. Negotiated Rate |
$980.05 |
| Rate for Payer: Adventist Health Commercial |
$472.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$634.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$667.82
|
| Rate for Payer: Blue Shield of California Commercial |
$850.91
|
| Rate for Payer: Blue Shield of California EPN |
$560.36
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$980.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$980.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$980.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$418.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$807.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$807.10
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$980.05
|
| Rate for Payer: Vantage Medical Group Senior |
$980.05
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
905355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| 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 |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
905355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| 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 |
$144.22
|
| Rate for Payer: Blue Shield of California Commercial |
$183.76
|
| Rate for Payer: Blue Shield of California EPN |
$121.01
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| 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 |
$124.50
|
| 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 |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| 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 WAIST BELT PAD & LINED
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
915355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA HMO |
$198.80
|
| Rate for Payer: Cigna of CA PPO |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$142.00
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.59
|
| Rate for Payer: United Healthcare All Other HMO |
$103.75
|
| Rate for Payer: United Healthcare HMO Rider |
$101.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.01
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
915355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Adventist Health Commercial |
$116.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.49
|
| Rate for Payer: Blue Shield of California Commercial |
$209.59
|
| Rate for Payer: Blue Shield of California EPN |
$138.02
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA HMO |
$198.80
|
| Rate for Payer: Cigna of CA PPO |
$198.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.80
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$142.00
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.59
|
| Rate for Payer: United Healthcare All Other HMO |
$103.75
|
| Rate for Payer: United Healthcare HMO Rider |
$101.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
IP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
915355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$495.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$495.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$944.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.72
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
IP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
905355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$495.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$495.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$944.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.72
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
OP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
905355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$594.72 |
| Max. Negotiated Rate |
$2,106.30 |
| Rate for Payer: Adventist Health Commercial |
$1,015.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,362.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,858.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,435.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,828.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,204.31
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,106.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,106.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$975.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,103.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,734.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,734.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,486.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,486.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,106.30
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
OP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
915355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$594.72 |
| Max. Negotiated Rate |
$2,106.30 |
| Rate for Payer: Adventist Health Commercial |
$1,015.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,362.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,858.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,435.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,828.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,204.31
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,106.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,106.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$975.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,103.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$594.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,734.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,734.60
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,486.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,486.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,106.30
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
915355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$384.14 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.43
|
| Rate for Payer: Blue Shield of California Commercial |
$325.46
|
| Rate for Payer: Blue Shield of California EPN |
$214.33
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$339.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.70
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.51
|
| Rate for Payer: United Healthcare All Other HMO |
$161.10
|
| Rate for Payer: United Healthcare HMO Rider |
$157.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.85
|
| Rate for Payer: Vantage Medical Group Senior |
$374.85
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
905355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.51
|
| Rate for Payer: United Healthcare All Other HMO |
$161.10
|
| Rate for Payer: United Healthcare HMO Rider |
$157.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.43
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
915355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.51
|
| Rate for Payer: United Healthcare All Other HMO |
$161.10
|
| Rate for Payer: United Healthcare HMO Rider |
$157.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.43
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
905355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$384.14 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.43
|
| Rate for Payer: Blue Shield of California Commercial |
$325.46
|
| Rate for Payer: Blue Shield of California EPN |
$214.33
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$339.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.70
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.51
|
| Rate for Payer: United Healthcare All Other HMO |
$161.10
|
| Rate for Payer: United Healthcare HMO Rider |
$157.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.85
|
| Rate for Payer: Vantage Medical Group Senior |
$374.85
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
915355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$352.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$352.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.40
|
| Rate for Payer: Multiplan Commercial |
$1,408.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
905355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$422.40 |
| Max. Negotiated Rate |
$1,496.00 |
| Rate for Payer: Adventist Health Commercial |
$721.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$968.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,019.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,298.88
|
| Rate for Payer: Blue Shield of California EPN |
$855.36
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,496.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,122.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,269.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,232.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,232.00
|
| Rate for Payer: Multiplan Commercial |
$1,408.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,056.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,056.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,496.00
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
915355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$422.40 |
| Max. Negotiated Rate |
$1,496.00 |
| Rate for Payer: Adventist Health Commercial |
$721.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$968.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,019.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,298.88
|
| Rate for Payer: Blue Shield of California EPN |
$855.36
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,496.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,122.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,269.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,232.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,232.00
|
| Rate for Payer: Multiplan Commercial |
$1,408.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,056.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,056.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,496.00
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
905355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$352.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$352.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.40
|
| Rate for Payer: Multiplan Commercial |
$1,408.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
915355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.56 |
| Max. Negotiated Rate |
$632.40 |
| Rate for Payer: Adventist Health Commercial |
$305.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$430.92
|
| Rate for Payer: Blue Shield of California Commercial |
$549.07
|
| Rate for Payer: Blue Shield of California EPN |
$361.58
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cash Price |
$334.80
|
| Rate for Payer: Cigna of CA HMO |
$520.80
|
| Rate for Payer: Cigna of CA PPO |
$520.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$632.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$520.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$520.80
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$372.00
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$446.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$446.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.22
|
| Rate for Payer: United Healthcare All Other HMO |
$271.78
|
| Rate for Payer: United Healthcare HMO Rider |
$265.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.40
|
| Rate for Payer: Vantage Medical Group Senior |
$632.40
|
|
