|
HC HD ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
915355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.50
|
| Rate for Payer: Blue Shield of California Commercial |
$549.81
|
| Rate for Payer: Blue Shield of California EPN |
$362.07
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
915355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.50
|
| Rate for Payer: Blue Shield of California Commercial |
$549.81
|
| Rate for Payer: Blue Shield of California EPN |
$362.07
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,063.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,063.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,836.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,676.32
|
| Rate for Payer: Multiplan Commercial |
$12,254.40
|
| Rate for Payer: Networks By Design Commercial |
$7,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
OP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,676.32 |
| Max. Negotiated Rate |
$13,020.30 |
| Rate for Payer: Adventist Health Commercial |
$6,280.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,424.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,488.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,872.19
|
| Rate for Payer: Blue Shield of California Commercial |
$11,304.68
|
| Rate for Payer: Blue Shield of California EPN |
$7,444.55
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,020.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,020.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,277.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,676.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,722.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,722.60
|
| Rate for Payer: Multiplan Commercial |
$12,254.40
|
| Rate for Payer: Networks By Design Commercial |
$7,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13,020.30
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
OP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,676.32 |
| Max. Negotiated Rate |
$13,020.30 |
| Rate for Payer: Adventist Health Commercial |
$6,280.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,424.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,488.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,872.19
|
| Rate for Payer: Blue Shield of California Commercial |
$11,304.68
|
| Rate for Payer: Blue Shield of California EPN |
$7,444.55
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,020.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,020.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,277.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,676.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,722.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,722.60
|
| Rate for Payer: Multiplan Commercial |
$12,254.40
|
| Rate for Payer: Networks By Design Commercial |
$7,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13,020.30
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,063.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,063.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,836.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,676.32
|
| Rate for Payer: Multiplan Commercial |
$12,254.40
|
| Rate for Payer: Networks By Design Commercial |
$7,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
IP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
915355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,910.20 |
| Max. Negotiated Rate |
$16,618.35 |
| Rate for Payer: Adventist Health Commercial |
$3,910.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,448.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,692.24
|
| Rate for Payer: Multiplan Commercial |
$15,640.80
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
OP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
905355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,500.45 |
| Max. Negotiated Rate |
$16,618.35 |
| Rate for Payer: Adventist Health Commercial |
$8,015.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,753.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,663.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,323.94
|
| Rate for Payer: Blue Shield of California Commercial |
$14,428.64
|
| Rate for Payer: Blue Shield of California EPN |
$9,501.79
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,618.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,618.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,500.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,958.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,692.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,685.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,685.70
|
| Rate for Payer: Multiplan Commercial |
$15,640.80
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,730.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,730.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16,618.35
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
IP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
905355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,910.20 |
| Max. Negotiated Rate |
$16,618.35 |
| Rate for Payer: Adventist Health Commercial |
$3,910.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,448.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,692.24
|
| Rate for Payer: Multiplan Commercial |
$15,640.80
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
OP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
915355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,500.45 |
| Max. Negotiated Rate |
$16,618.35 |
| Rate for Payer: Adventist Health Commercial |
$8,015.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,753.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,663.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,323.94
|
| Rate for Payer: Blue Shield of California Commercial |
$14,428.64
|
| Rate for Payer: Blue Shield of California EPN |
$9,501.79
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,618.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,618.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,500.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,958.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,692.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,685.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,685.70
|
| Rate for Payer: Multiplan Commercial |
$15,640.80
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,730.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,730.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16,618.35
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
OP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
915355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,098.56 |
| Max. Negotiated Rate |
$7,432.40 |
| Rate for Payer: Adventist Health Commercial |
$3,585.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,809.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,064.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6,453.07
|
| Rate for Payer: Blue Shield of California EPN |
$4,249.58
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,432.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,432.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,762.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,517.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,098.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,120.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,120.80
|
| Rate for Payer: Multiplan Commercial |
$6,995.20
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,432.40
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
IP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
915355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,748.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,331.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,098.56
|
| Rate for Payer: Multiplan Commercial |
$6,995.20
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
IP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
905355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,748.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,331.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,098.56
|
| Rate for Payer: Multiplan Commercial |
$6,995.20
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
OP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
905355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,098.56 |
| Max. Negotiated Rate |
$7,432.40 |
| Rate for Payer: Adventist Health Commercial |
$3,585.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,809.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,064.52
|
| Rate for Payer: Blue Shield of California Commercial |
$6,453.07
|
| Rate for Payer: Blue Shield of California EPN |
$4,249.58
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,432.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,432.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,762.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,517.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,098.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,120.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,120.80
|
| Rate for Payer: Multiplan Commercial |
$6,995.20
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,432.40
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
915355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,798.56 |
| Max. Negotiated Rate |
$6,369.90 |
| Rate for Payer: Adventist Health Commercial |
$3,072.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,121.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,620.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,340.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5,530.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,642.08
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,369.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,408.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,117.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,245.80
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,496.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,369.90
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
OP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,798.56 |
| Max. Negotiated Rate |
$6,369.90 |
| Rate for Payer: Adventist Health Commercial |
$3,072.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,121.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,620.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,340.52
|
| Rate for Payer: Blue Shield of California Commercial |
$5,530.57
|
| Rate for Payer: Blue Shield of California EPN |
$3,642.08
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,369.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,408.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,117.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,245.80
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,496.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,369.90
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,498.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,498.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,855.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
|
IP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
915355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,498.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,498.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cash Price |
$4,121.70
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,855.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,638.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,798.56
|
| Rate for Payer: Multiplan Commercial |
$5,995.20
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,737.56
|
| Rate for Payer: United Healthcare HMO Rider |
$2,678.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,454.28
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
IP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
915355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,423.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,710.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
OP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
915355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$6,047.75 |
| Rate for Payer: Adventist Health Commercial |
$2,917.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,913.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,336.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,121.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,250.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,457.89
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,047.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,047.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,980.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,980.50
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,047.75
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
IP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,423.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,710.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
|
OP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,707.60 |
| Max. Negotiated Rate |
$6,047.75 |
| Rate for Payer: Adventist Health Commercial |
$2,917.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,913.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,336.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,121.01
|
| Rate for Payer: Blue Shield of California Commercial |
$5,250.87
|
| Rate for Payer: Blue Shield of California EPN |
$3,457.89
|
| Rate for Payer: Cash Price |
$3,913.25
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,047.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,047.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,404.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,980.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,980.50
|
| Rate for Payer: Multiplan Commercial |
$5,692.00
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,670.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,599.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,542.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,330.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,047.75
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
|
IP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,868.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cash Price |
$5,137.55
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,558.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,782.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,241.84
|
| Rate for Payer: Multiplan Commercial |
$7,472.80
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,505.68
|
| Rate for Payer: United Healthcare All Other HMO |
$3,412.27
|
| Rate for Payer: United Healthcare HMO Rider |
$3,338.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,059.18
|
|
