|
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 |
$210.04
|
| Rate for Payer: Blue Shield of California Commercial |
$266.84
|
| Rate for Payer: Blue Shield of California Commercial |
$175.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.73
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.73
|
| 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 |
$225.55
|
| 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
|
IP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
915355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.73
|
| 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 |
$225.55
|
| 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: 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 |
$210.04
|
| Rate for Payer: Blue Shield of California Commercial |
$266.84
|
| Rate for Payer: Blue Shield of California Commercial |
$175.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$204.73
|
| 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 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 |
$429.76
|
| Rate for Payer: Blue Shield of California Commercial |
$545.99
|
| Rate for Payer: Blue Shield of California Commercial |
$359.97
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| 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
|
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 |
$429.76
|
| Rate for Payer: Blue Shield of California Commercial |
$545.99
|
| Rate for Payer: Blue Shield of California Commercial |
$359.97
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$226.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$256.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| 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 |
915355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| 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 |
$461.50
|
| 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
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
905355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.90
|
| 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 |
$461.50
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$732.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$680.27
|
| 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 |
$749.45
|
| 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 |
$697.91
|
| Rate for Payer: Blue Shield of California Commercial |
$886.66
|
| Rate for Payer: Blue Shield of California Commercial |
$584.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$418.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$732.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$472.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$680.27
|
| 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
|
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 |
$697.91
|
| Rate for Payer: Blue Shield of California Commercial |
$886.66
|
| Rate for Payer: Blue Shield of California Commercial |
$584.57
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$418.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$732.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$472.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$680.27
|
| 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 |
915355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$732.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$680.27
|
| 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 |
$749.45
|
| 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 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 |
$171.91
|
| Rate for Payer: Blue Shield of California Commercial |
$218.40
|
| Rate for Payer: Blue Shield of California Commercial |
$143.99
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.56
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| 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
|
| 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 |
$150.72
|
| Rate for Payer: Blue Shield of California Commercial |
$191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$126.24
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.56
|
| 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 |
$184.60
|
| 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 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: Vantage Medical Group Senior |
$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 |
$1,499.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,905.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,256.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$975.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,573.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,103.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,462.02
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$495.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,573.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,462.02
|
| 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 |
$1,610.70
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$495.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,573.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,462.02
|
| 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 |
$1,610.70
|
| 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 |
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 |
$1,499.93
|
| Rate for Payer: Blue Shield of California Commercial |
$1,905.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,256.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$975.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,573.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,103.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,462.02
|
| 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 |
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 |
$266.94
|
| Rate for Payer: Blue Shield of California Commercial |
$339.13
|
| Rate for Payer: Blue Shield of California Commercial |
$223.59
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$339.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| 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
|
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 |
$266.94
|
| Rate for Payer: Blue Shield of California Commercial |
$339.13
|
| Rate for Payer: Blue Shield of California Commercial |
$223.59
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$339.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| 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 |
915355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| 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 |
$286.65
|
| 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 |
905355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| 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 |
$286.65
|
| 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 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 |
$1,065.33
|
| Rate for Payer: Blue Shield of California Commercial |
$892.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,353.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,122.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,117.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,269.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,038.40
|
| 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
|
|
