|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
915355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
915355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.16 |
| Max. Negotiated Rate |
$815.15 |
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$555.45
|
| Rate for Payer: Blue Shield of California Commercial |
$707.74
|
| Rate for Payer: Blue Shield of California EPN |
$466.07
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$230.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.16
|
| Rate for Payer: Multiplan Commercial |
$767.20
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
|
|
HC KD ADD SKT INSERT SILICONE GEL
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT L5663
|
| Hospital Charge Code |
905355663
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$448.32 |
| Max. Negotiated Rate |
$1,587.80 |
| Rate for Payer: Adventist Health Commercial |
$765.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,081.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,378.58
|
| Rate for Payer: Blue Shield of California EPN |
$907.85
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,587.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,587.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,307.60
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,587.80
|
|
|
HC KD ADD SKT INSERT SILICONE GEL
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT L5663
|
| Hospital Charge Code |
905355663
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
OP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
915355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,298.56 |
| Max. Negotiated Rate |
$12,750.85 |
| Rate for Payer: Adventist Health Commercial |
$6,150.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,688.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11,070.74
|
| Rate for Payer: Blue Shield of California EPN |
$7,290.49
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,298.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.70
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.85
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
IP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
OP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,298.56 |
| Max. Negotiated Rate |
$12,750.85 |
| Rate for Payer: Adventist Health Commercial |
$6,150.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,688.58
|
| Rate for Payer: Blue Shield of California Commercial |
$11,070.74
|
| Rate for Payer: Blue Shield of California EPN |
$7,290.49
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,298.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,500.70
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.85
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
IP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
915355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cash Price |
$8,250.55
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,600.24
|
| Rate for Payer: Multiplan Commercial |
$12,000.80
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,726.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,347.44 |
| Max. Negotiated Rate |
$8,313.85 |
| Rate for Payer: Adventist Health Commercial |
$4,010.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,665.16
|
| Rate for Payer: Blue Shield of California Commercial |
$7,218.38
|
| Rate for Payer: Blue Shield of California EPN |
$4,753.57
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,313.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,400.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,846.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,846.70
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,347.44 |
| Max. Negotiated Rate |
$8,313.85 |
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: Adventist Health Commercial |
$4,010.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,665.16
|
| Rate for Payer: Blue Shield of California Commercial |
$7,218.38
|
| Rate for Payer: Blue Shield of California EPN |
$4,753.57
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,313.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,400.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,846.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,846.70
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cash Price |
$5,379.55
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,726.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,347.44
|
| Rate for Payer: Multiplan Commercial |
$7,824.80
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
OP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,689.52 |
| Max. Negotiated Rate |
$13,067.05 |
| Rate for Payer: Adventist Health Commercial |
$6,302.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,455.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,529.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,904.04
|
| Rate for Payer: Blue Shield of California Commercial |
$11,345.27
|
| Rate for Payer: Blue Shield of California EPN |
$7,471.28
|
| Rate for Payer: Cash Price |
$8,455.15
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,067.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,067.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,253.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,857.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,515.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,689.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,761.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,761.10
|
| Rate for Payer: Multiplan Commercial |
$12,298.40
|
| Rate for Payer: Networks By Design Commercial |
$7,686.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,223.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13,067.05
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
IP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,074.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$3,074.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,455.15
|
| Rate for Payer: Cash Price |
$8,455.15
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,253.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,857.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,515.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,689.52
|
| Rate for Payer: Multiplan Commercial |
$12,298.40
|
| Rate for Payer: Networks By Design Commercial |
$7,686.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
|
|
HC KD PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$6,320.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,264.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,264.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,476.00
|
| Rate for Payer: Cash Price |
$3,476.00
|
| Rate for Payer: Cigna of CA HMO |
$4,424.00
|
| Rate for Payer: Cigna of CA PPO |
$4,424.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,528.00
|
| Rate for Payer: Galaxy Health WC |
$5,372.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,912.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.80
|
| Rate for Payer: Multiplan Commercial |
$5,056.00
|
| Rate for Payer: Networks By Design Commercial |
$3,160.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.80
|
|
|
HC KD PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$6,320.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,516.80 |
| Max. Negotiated Rate |
$5,372.00 |
| Rate for Payer: Adventist Health Commercial |
$2,591.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,476.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,740.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,660.54
|
| Rate for Payer: Blue Shield of California Commercial |
$4,664.16
|
| Rate for Payer: Blue Shield of California EPN |
$3,071.52
|
| Rate for Payer: Cash Price |
$3,476.00
|
| Rate for Payer: Cigna of CA HMO |
$4,424.00
|
| Rate for Payer: Cigna of CA PPO |
$4,424.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,372.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,528.00
|
| Rate for Payer: Galaxy Health WC |
$5,372.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,912.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,424.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,424.00
|
| Rate for Payer: Multiplan Commercial |
$5,056.00
|
| Rate for Payer: Networks By Design Commercial |
$3,160.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,372.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,792.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,372.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,372.00
|
| Rate for Payer: Vantage Medical Group Senior |
$5,372.00
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.16 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.73
|
| Rate for Payer: Blue Shield of California Commercial |
$910.69
|
| Rate for Payer: Blue Shield of California EPN |
$599.72
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$296.16 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.73
|
| Rate for Payer: Blue Shield of California Commercial |
$910.69
|
| Rate for Payer: Blue Shield of California EPN |
$599.72
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$741.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$863.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cash Price |
$678.70
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,553.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$310.60 |
| Max. Negotiated Rate |
$1,320.05 |
| Rate for Payer: Adventist Health Commercial |
$310.60
|
| Rate for Payer: Cash Price |
$854.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$621.20
|
| Rate for Payer: EPIC Health Plan Senior |
$621.20
|
| Rate for Payer: Galaxy Health WC |
$1,320.05
|
| Rate for Payer: Global Benefits Group Commercial |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$961.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.72
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,009.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,320.05
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,553.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$129.38 |
| Max. Negotiated Rate |
$1,320.05 |
| Rate for Payer: Adventist Health Commercial |
$310.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,018.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$953.70
|
| Rate for Payer: Blue Shield of California Commercial |
$950.44
|
| Rate for Payer: Blue Shield of California EPN |
$627.41
|
| Rate for Payer: Cash Price |
$854.15
|
| Rate for Payer: Cash Price |
$854.15
|
| Rate for Payer: Cigna of CA HMO |
$993.92
|
| Rate for Payer: Cigna of CA PPO |
$1,149.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,320.05
|
| Rate for Payer: Global Benefits Group Commercial |
$931.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: Networks By Design Commercial |
$1,009.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,320.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$2,062.10 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Cash Price |
$1,334.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,576.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$201.31 |
| Max. Negotiated Rate |
$2,062.10 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,591.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,489.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,484.71
|
| Rate for Payer: Blue Shield of California EPN |
$980.10
|
| Rate for Payer: Cash Price |
$1,334.30
|
| Rate for Payer: Cash Price |
$1,334.30
|
| Rate for Payer: Cigna of CA HMO |
$1,552.64
|
| Rate for Payer: Cigna of CA PPO |
$1,795.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$201.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$582.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,940.80
|
| Rate for Payer: Networks By Design Commercial |
$1,576.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
