|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$352.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,117.60
|
| 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: Multiplan Commercial |
$1,408.00
|
| Rate for Payer: Networks By Design Commercial |
$1,144.00
|
| 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 |
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 |
$1,065.33
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$352.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,117.60
|
| 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: Multiplan Commercial |
$1,408.00
|
| Rate for Payer: Networks By Design Commercial |
$1,144.00
|
| 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 |
$450.34
|
| Rate for Payer: Blue Shield of California Commercial |
$572.14
|
| Rate for Payer: Blue Shield of California Commercial |
$377.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$520.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$472.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.96
|
| 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
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
915355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$520.80
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$472.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.56
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| 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
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.72 |
| Max. Negotiated Rate |
$555.05 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.26
|
| Rate for Payer: Blue Shield of California Commercial |
$502.16
|
| Rate for Payer: Blue Shield of California Commercial |
$331.07
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$414.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$385.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
OP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,175.92 |
| Max. Negotiated Rate |
$11,248.05 |
| Rate for Payer: Adventist Health Commercial |
$5,425.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,278.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,009.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,709.13
|
| Rate for Payer: Blue Shield of California Commercial |
$10,176.18
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,248.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,248.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,285.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,402.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,175.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,263.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,263.10
|
| Rate for Payer: Multiplan Commercial |
$10,586.40
|
| Rate for Payer: Networks By Design Commercial |
$6,616.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,939.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,939.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11,248.05
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
OP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,175.92 |
| Max. Negotiated Rate |
$11,248.05 |
| Rate for Payer: Adventist Health Commercial |
$5,425.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,278.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,009.93
|
| Rate for Payer: Blue Shield of California Commercial |
$6,709.13
|
| Rate for Payer: Blue Shield of California Commercial |
$10,176.18
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,248.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,248.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,285.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,402.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,175.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,263.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,263.10
|
| Rate for Payer: Multiplan Commercial |
$10,586.40
|
| Rate for Payer: Networks By Design Commercial |
$6,616.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,939.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,939.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11,248.05
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
IP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,646.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,646.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,402.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,175.92
|
| Rate for Payer: Multiplan Commercial |
$10,586.40
|
| Rate for Payer: Networks By Design Commercial |
$8,601.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
IP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,646.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,646.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cash Price |
$5,954.85
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,402.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,807.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,175.92
|
| Rate for Payer: Multiplan Commercial |
$10,586.40
|
| Rate for Payer: Networks By Design Commercial |
$8,601.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
IP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
905355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,348.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,718.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,280.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,977.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.84
|
| Rate for Payer: Multiplan Commercial |
$5,392.80
|
| Rate for Payer: Networks By Design Commercial |
$4,381.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
IP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
915355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,348.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,718.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,280.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,977.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.84
|
| Rate for Payer: Multiplan Commercial |
$5,392.80
|
| Rate for Payer: Networks By Design Commercial |
$4,381.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
OP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
915355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,617.84 |
| Max. Negotiated Rate |
$5,729.85 |
| Rate for Payer: Adventist Health Commercial |
$2,763.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,707.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,055.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,080.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5,183.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,417.69
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,729.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,729.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,718.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,717.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,280.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,942.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,977.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,718.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,718.70
|
| Rate for Payer: Multiplan Commercial |
$5,392.80
|
| Rate for Payer: Networks By Design Commercial |
$3,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,044.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,044.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,729.85
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
OP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
905355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,617.84 |
| Max. Negotiated Rate |
$5,729.85 |
| Rate for Payer: Adventist Health Commercial |
$2,763.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,707.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,055.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,080.33
|
| Rate for Payer: Blue Shield of California Commercial |
$5,183.83
|
| Rate for Payer: Blue Shield of California Commercial |
$3,417.69
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,729.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,729.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,718.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,717.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,280.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,942.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,977.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,718.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,718.70
|
| Rate for Payer: Multiplan Commercial |
$5,392.80
|
| Rate for Payer: Networks By Design Commercial |
$3,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,044.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,044.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,729.85
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
OP
|
$3,211.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
915355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$770.64 |
| Max. Negotiated Rate |
$2,729.35 |
| Rate for Payer: Adventist Health Commercial |
$1,316.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,729.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,766.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,408.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,943.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,469.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,627.98
|
| Rate for Payer: Cash Price |
$1,444.95
|
| Rate for Payer: Cash Price |
$1,444.95
|
| Rate for Payer: Cigna of CA HMO |
$2,247.70
|
| Rate for Payer: Cigna of CA PPO |
$2,247.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,729.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,729.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,247.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,284.40
|
| Rate for Payer: Galaxy Health WC |
$2,729.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,926.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,033.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,038.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,299.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,894.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,247.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,247.70
|
| Rate for Payer: Multiplan Commercial |
$2,568.80
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,729.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,926.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,926.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,205.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1,172.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,051.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,729.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,729.35
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
905355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$563.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$563.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,267.65
|
| Rate for Payer: Cash Price |
$1,267.65
|
| Rate for Payer: Cigna of CA HMO |
$1,971.90
|
| Rate for Payer: Cigna of CA PPO |
$1,971.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,971.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,126.80
|
| Rate for Payer: Galaxy Health WC |
$2,394.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,690.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,788.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,662.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.08
|
| Rate for Payer: Multiplan Commercial |
$2,253.60
|
| Rate for Payer: Networks By Design Commercial |
$1,831.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,394.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,057.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,029.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1,006.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$922.57
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
IP
|
$3,211.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
915355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$642.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$642.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,444.95
|
| Rate for Payer: Cash Price |
$1,444.95
|
| Rate for Payer: Cigna of CA HMO |
$2,247.70
|
| Rate for Payer: Cigna of CA PPO |
$2,247.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,247.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,284.40
|
| Rate for Payer: Galaxy Health WC |
$2,729.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,926.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,038.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,894.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$770.64
|
| Rate for Payer: Multiplan Commercial |
$2,568.80
|
| Rate for Payer: Networks By Design Commercial |
$2,087.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,729.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,205.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1,172.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,051.60
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
905355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$676.08 |
| Max. Negotiated Rate |
$2,394.45 |
| Rate for Payer: Adventist Health Commercial |
$1,154.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,549.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,112.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,705.13
|
| Rate for Payer: Blue Shield of California Commercial |
$2,166.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,428.22
|
| Rate for Payer: Cash Price |
$1,267.65
|
| Rate for Payer: Cash Price |
$1,267.65
|
| Rate for Payer: Cigna of CA HMO |
$1,971.90
|
| Rate for Payer: Cigna of CA PPO |
$1,971.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,394.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,394.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,971.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,126.80
|
| Rate for Payer: Galaxy Health WC |
$2,394.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,690.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,033.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,788.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,299.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,662.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$676.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,971.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,971.90
|
| Rate for Payer: Multiplan Commercial |
$2,253.60
|
| Rate for Payer: Networks By Design Commercial |
$1,408.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,394.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,690.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,690.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,057.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,029.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1,006.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$922.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,394.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,394.45
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
905355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
915355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$892.08 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$1,523.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,249.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,858.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,884.52
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,856.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,099.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$1,858.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
915355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
905355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$892.08 |
| Max. Negotiated Rate |
$3,159.45 |
| Rate for Payer: Adventist Health Commercial |
$1,523.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,249.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,858.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,884.52
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,856.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,099.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,973.60
|
| Rate for Payer: Networks By Design Commercial |
$1,858.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
OP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
915355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$994.32 |
| Max. Negotiated Rate |
$3,521.55 |
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Adventist Health Commercial |
$1,698.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,278.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,507.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,185.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,100.50
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,521.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,521.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,789.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,630.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,023.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,444.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,900.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,900.10
|
| Rate for Payer: Multiplan Commercial |
$3,314.40
|
| Rate for Payer: Networks By Design Commercial |
$2,071.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,521.55
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
IP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
915355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$828.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,630.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,444.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.32
|
| Rate for Payer: Multiplan Commercial |
$3,314.40
|
| Rate for Payer: Networks By Design Commercial |
$2,692.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
|
