|
HC ADD. LE FOOT LAMIN/PREPREG COMPOSIT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT L3031
|
| Hospital Charge Code |
905353031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Blue Shield of California Commercial |
$419.45
|
| Rate for Payer: Blue Shield of California EPN |
$263.59
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$332.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$308.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
|
|
HC ADD/LE PROS VACUUM PUMP VLM MG
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT L5781
|
| Hospital Charge Code |
915355781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,413.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,286.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,982.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$4,387.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC ADD/LE PROS VACUUM PUMP VLM MG
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT L5781
|
| Hospital Charge Code |
905355781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,210.62 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$2,767.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,926.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,413.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,334.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,286.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,788.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,982.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,767.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC ADD/LE PROS VACUUM PUMP VLM MG
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT L5781
|
| Hospital Charge Code |
905355781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,413.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,286.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,982.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$4,387.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
|
|
HC ADD/LE PROS VACUUM PUMP VLM MG
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT L5781
|
| Hospital Charge Code |
915355781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,210.62 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Adventist Health Commercial |
$2,767.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,062.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,926.47
|
| Rate for Payer: Blue Shield of California Commercial |
$5,413.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,737.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,334.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,286.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,788.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,982.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,767.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,725.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,533.28
|
| Rate for Payer: United Healthcare All Other HMO |
$2,465.78
|
| Rate for Payer: United Healthcare HMO Rider |
$2,412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,210.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC ADD LE SILICONE INSERT NO LOCK
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
915355679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Blue Shield of California Commercial |
$899.84
|
| Rate for Payer: Blue Shield of California EPN |
$565.49
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.40
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$729.30
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
|
|
HC ADD LE SILICONE INSERT NO LOCK
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
905355679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$367.45 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Adventist Health Commercial |
$460.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$652.67
|
| Rate for Payer: Blue Shield of California Commercial |
$899.84
|
| Rate for Payer: Blue Shield of California EPN |
$565.49
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$953.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$953.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$953.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$720.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$785.40
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: Riverside University Health System MISP |
$448.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$953.70
|
| Rate for Payer: Vantage Medical Group Senior |
$953.70
|
|
|
HC ADD LE SILICONE INSERT NO LOCK
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
915355679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$367.45 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Dignity Health Medi-Cal |
$953.70
|
| Rate for Payer: Adventist Health Commercial |
$460.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$652.67
|
| Rate for Payer: Blue Shield of California Commercial |
$899.84
|
| Rate for Payer: Blue Shield of California EPN |
$565.49
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$953.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$953.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$720.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$785.40
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: Riverside University Health System MISP |
$448.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$953.70
|
| Rate for Payer: Vantage Medical Group Senior |
$953.70
|
|
|
HC ADD LE SILICONE INSERT NO LOCK
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
905355679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Blue Shield of California Commercial |
$899.84
|
| Rate for Payer: Blue Shield of California EPN |
$565.49
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.40
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$729.30
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
|
|
HC ADD LE SILICONE INSERT W/LOCK
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
905355673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$440.81 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$551.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$740.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.49
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,144.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,144.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$942.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Riverside University Health System MISP |
$538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.10
|
|
|
HC ADD LE SILICONE INSERT W/LOCK
|
Facility
|
IP
|
$1,534.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
915355673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.80 |
| Max. Negotiated Rate |
$1,380.60 |
| Rate for Payer: Adventist Health Commercial |
$306.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,230.27
|
| Rate for Payer: Blue Shield of California EPN |
$773.14
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,227.20
|
| Rate for Payer: Cigna of CA HMO |
$1,073.80
|
| Rate for Payer: Cigna of CA PPO |
$1,073.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.60
|
| Rate for Payer: EPIC Health Plan Senior |
$613.60
|
| Rate for Payer: Galaxy Health WC |
$1,303.90
|
| Rate for Payer: Global Benefits Group Commercial |
$920.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,380.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$974.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$905.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.80
|
| Rate for Payer: Multiplan Commercial |
$1,150.50
|
| Rate for Payer: Networks By Design Commercial |
$997.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$575.71
|
| Rate for Payer: United Healthcare All Other HMO |
$560.37
|
| Rate for Payer: United Healthcare HMO Rider |
$548.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$502.38
|
|
|
HC ADD LE SILICONE INSERT W/LOCK
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
905355673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.49
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$874.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
|
|
HC ADD LE SILICONE INSERT W/LOCK
|
Facility
|
OP
|
$1,534.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
915355673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.38 |
| Max. Negotiated Rate |
$1,380.60 |
| Rate for Payer: Networks By Design Commercial |
$767.00
|
| Rate for Payer: Adventist Health Commercial |
$628.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,303.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$843.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,150.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$892.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,230.27
|
| Rate for Payer: Blue Shield of California EPN |
$773.14
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Cash Price |
$690.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,227.20
|
| Rate for Payer: Cigna of CA HMO |
$1,073.80
|
| Rate for Payer: Cigna of CA PPO |
$1,073.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,303.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,303.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,073.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$613.60
|
| Rate for Payer: EPIC Health Plan Senior |
$613.60
|
| Rate for Payer: Galaxy Health WC |
$1,303.90
|
| Rate for Payer: Global Benefits Group Commercial |
$920.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,380.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$974.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$905.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,073.80
|
| Rate for Payer: Multiplan Commercial |
$1,150.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,303.90
|
| Rate for Payer: Riverside University Health System MISP |
$613.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$920.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$920.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$575.71
|
| Rate for Payer: United Healthcare All Other HMO |
$560.37
|
| Rate for Payer: United Healthcare HMO Rider |
$548.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$502.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,303.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,303.90
|
|
|
HC ADDL PMP NW SUBC THER INF SITE
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
907296371
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$1,029.00 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$92.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$521.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Central Health Plan Commercial |
$220.00
|
| Rate for Payer: Cigna of CA HMO |
$176.00
|
| Rate for Payer: Cigna of CA PPO |
$203.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$101.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.79
|
| Rate for Payer: EPIC Health Plan Senior |
$101.86
|
| Rate for Payer: Galaxy Health WC |
$233.75
|
| Rate for Payer: Global Benefits Group Commercial |
$165.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$151.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$92.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$128.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$129.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$206.25
|
| Rate for Payer: Networks By Design Commercial |
$178.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$92.60
|
| Rate for Payer: Prime Health Services Commercial |
$233.75
|
| Rate for Payer: Prime Health Services Medicare |
$98.16
|
| Rate for Payer: Riverside University Health System MISP |
$101.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$165.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$111.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$92.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$101.86
|
| Rate for Payer: Vantage Medical Group Senior |
$92.60
|
|
|
HC ADDL PMP NW SUBC THER INF SITE
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
907296371
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Adventist Health Commercial |
$55.00
|
| Rate for Payer: Cash Price |
$123.75
|
| Rate for Payer: Central Health Plan Commercial |
$220.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.00
|
| Rate for Payer: EPIC Health Plan Senior |
$110.00
|
| Rate for Payer: Galaxy Health WC |
$233.75
|
| Rate for Payer: Global Benefits Group Commercial |
$165.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.00
|
| Rate for Payer: Multiplan Commercial |
$206.25
|
| Rate for Payer: Networks By Design Commercial |
$178.75
|
| Rate for Payer: Prime Health Services Commercial |
$233.75
|
|
|
HC ADDN ENDO KNEE/SHIN HYDRAULIC
|
Facility
|
IP
|
$6,265.00
|
|
|
Service Code
|
CPT L5814
|
| Hospital Charge Code |
905355814
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,253.00 |
| Max. Negotiated Rate |
$5,638.50 |
| Rate for Payer: Adventist Health Commercial |
$1,253.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,024.53
|
| Rate for Payer: Blue Shield of California EPN |
$3,157.56
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,012.00
|
| Rate for Payer: Cigna of CA HMO |
$4,385.50
|
| Rate for Payer: Cigna of CA PPO |
$4,385.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,385.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,506.00
|
| Rate for Payer: Galaxy Health WC |
$5,325.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,638.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,978.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,696.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.00
|
| Rate for Payer: Multiplan Commercial |
$4,698.75
|
| Rate for Payer: Networks By Design Commercial |
$4,072.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,325.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,351.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2,288.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,239.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,051.79
|
|
|
HC ADDN ENDO KNEE/SHIN HYDRAULIC
|
Facility
|
OP
|
$6,265.00
|
|
|
Service Code
|
CPT L5814
|
| Hospital Charge Code |
905355814
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,051.79 |
| Max. Negotiated Rate |
$5,638.50 |
| Rate for Payer: Adventist Health Commercial |
$2,568.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,445.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,698.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,644.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,024.53
|
| Rate for Payer: Blue Shield of California EPN |
$3,157.56
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,012.00
|
| Rate for Payer: Cigna of CA HMO |
$4,385.50
|
| Rate for Payer: Cigna of CA PPO |
$4,385.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,325.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,325.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,385.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,506.00
|
| Rate for Payer: Galaxy Health WC |
$5,325.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,638.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,790.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,978.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,083.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,696.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,568.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,385.50
|
| Rate for Payer: Multiplan Commercial |
$4,698.75
|
| Rate for Payer: Networks By Design Commercial |
$3,132.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,325.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,351.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2,288.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,239.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,051.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,325.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,325.25
|
|
|
HC ADDN ENDO KNEE/SHIN HYDRAULIC
|
Facility
|
OP
|
$6,265.00
|
|
|
Service Code
|
CPT L5814
|
| Hospital Charge Code |
915355814
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,051.79 |
| Max. Negotiated Rate |
$5,638.50 |
| Rate for Payer: Adventist Health Commercial |
$2,568.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,445.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,698.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,644.35
|
| Rate for Payer: Blue Shield of California Commercial |
$5,024.53
|
| Rate for Payer: Blue Shield of California EPN |
$3,157.56
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,012.00
|
| Rate for Payer: Cigna of CA HMO |
$4,385.50
|
| Rate for Payer: Cigna of CA PPO |
$4,385.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,325.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,325.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,385.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,506.00
|
| Rate for Payer: Galaxy Health WC |
$5,325.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,638.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,790.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,978.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,083.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,696.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,568.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,385.50
|
| Rate for Payer: Multiplan Commercial |
$4,698.75
|
| Rate for Payer: Networks By Design Commercial |
$3,132.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,325.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,351.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2,288.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,239.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,051.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,325.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,325.25
|
|
|
HC ADDN ENDO KNEE/SHIN HYDRAULIC
|
Facility
|
IP
|
$6,265.00
|
|
|
Service Code
|
CPT L5814
|
| Hospital Charge Code |
915355814
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,253.00 |
| Max. Negotiated Rate |
$5,638.50 |
| Rate for Payer: United Healthcare HMO Rider |
$2,239.11
|
| Rate for Payer: Adventist Health Commercial |
$1,253.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,024.53
|
| Rate for Payer: Blue Shield of California EPN |
$3,157.56
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,012.00
|
| Rate for Payer: Cigna of CA HMO |
$4,385.50
|
| Rate for Payer: Cigna of CA PPO |
$4,385.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,385.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,506.00
|
| Rate for Payer: Galaxy Health WC |
$5,325.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,638.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,978.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,696.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.00
|
| Rate for Payer: Multiplan Commercial |
$4,698.75
|
| Rate for Payer: Networks By Design Commercial |
$4,072.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,325.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,351.25
|
| Rate for Payer: United Healthcare All Other HMO |
$2,288.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,051.79
|
|
|
HC ADDN LE VERTICAL LOADING PYLON
|
Facility
|
IP
|
$2,171.00
|
|
|
Service Code
|
CPT L5988
|
| Hospital Charge Code |
915355988
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$434.20 |
| Max. Negotiated Rate |
$1,953.90 |
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,736.80
|
| Rate for Payer: Cigna of CA HMO |
$1,519.70
|
| Rate for Payer: Cigna of CA PPO |
$1,519.70
|
| Rate for Payer: Adventist Health Commercial |
$434.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,741.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,094.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,519.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$868.40
|
| Rate for Payer: Galaxy Health WC |
$1,845.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,302.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,953.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,378.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,280.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.20
|
| Rate for Payer: Multiplan Commercial |
$1,628.25
|
| Rate for Payer: Networks By Design Commercial |
$1,411.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,845.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.78
|
| Rate for Payer: United Healthcare All Other HMO |
$793.07
|
| Rate for Payer: United Healthcare HMO Rider |
$775.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
|
|
HC ADDN LE VERTICAL LOADING PYLON
|
Facility
|
OP
|
$2,171.00
|
|
|
Service Code
|
CPT L5988
|
| Hospital Charge Code |
905355988
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$1,953.90 |
| Rate for Payer: Adventist Health Commercial |
$890.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,194.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,628.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,262.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,741.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,094.18
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,736.80
|
| Rate for Payer: Cigna of CA HMO |
$1,519.70
|
| Rate for Payer: Cigna of CA PPO |
$1,519.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,845.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,845.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,519.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$868.40
|
| Rate for Payer: Galaxy Health WC |
$1,845.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,302.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,953.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,378.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,696.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,280.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,519.70
|
| Rate for Payer: Multiplan Commercial |
$1,628.25
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,845.35
|
| Rate for Payer: Riverside University Health System MISP |
$868.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,302.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,302.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.78
|
| Rate for Payer: United Healthcare All Other HMO |
$793.07
|
| Rate for Payer: United Healthcare HMO Rider |
$775.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,845.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,845.35
|
|
|
HC ADDN LE VERTICAL LOADING PYLON
|
Facility
|
IP
|
$2,171.00
|
|
|
Service Code
|
CPT L5988
|
| Hospital Charge Code |
905355988
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$434.20 |
| Max. Negotiated Rate |
$1,953.90 |
| Rate for Payer: Adventist Health Commercial |
$434.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,741.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,094.18
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,736.80
|
| Rate for Payer: Cigna of CA HMO |
$1,519.70
|
| Rate for Payer: Cigna of CA PPO |
$1,519.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,519.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$868.40
|
| Rate for Payer: Galaxy Health WC |
$1,845.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,302.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,953.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,378.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,280.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.20
|
| Rate for Payer: Multiplan Commercial |
$1,628.25
|
| Rate for Payer: Networks By Design Commercial |
$1,411.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,845.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.78
|
| Rate for Payer: United Healthcare All Other HMO |
$793.07
|
| Rate for Payer: United Healthcare HMO Rider |
$775.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
|
|
HC ADDN LE VERTICAL LOADING PYLON
|
Facility
|
OP
|
$2,171.00
|
|
|
Service Code
|
CPT L5988
|
| Hospital Charge Code |
915355988
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$1,953.90 |
| Rate for Payer: Adventist Health Commercial |
$890.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,194.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,628.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,262.87
|
| Rate for Payer: Blue Shield of California Commercial |
$1,741.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,094.18
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,736.80
|
| Rate for Payer: Cigna of CA HMO |
$1,519.70
|
| Rate for Payer: Cigna of CA PPO |
$1,519.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,845.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,845.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,519.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$868.40
|
| Rate for Payer: Galaxy Health WC |
$1,845.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,302.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,953.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,535.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,378.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,696.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,280.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,519.70
|
| Rate for Payer: Multiplan Commercial |
$1,628.25
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,845.35
|
| Rate for Payer: Riverside University Health System MISP |
$868.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,302.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,302.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$814.78
|
| Rate for Payer: United Healthcare All Other HMO |
$793.07
|
| Rate for Payer: United Healthcare HMO Rider |
$775.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,845.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,845.35
|
|
|
HC ADDNL:OBSTACLES/STAIRS LE
|
Facility
|
IP
|
$15,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.00 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: Adventist Health Commercial |
$3,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12,030.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$6,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$9,750.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
|
|
HC ADDNL:OBSTACLES/STAIRS LE
|
Facility
|
OP
|
$15,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380022
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,912.50 |
| Max. Negotiated Rate |
$13,500.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.00
|
| Rate for Payer: Galaxy Health WC |
$12,750.00
|
| Rate for Payer: Adventist Health Commercial |
$6,150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,725.50
|
| Rate for Payer: Blue Shield of California Commercial |
$12,030.00
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.00
|
| Rate for Payer: Cash Price |
$6,750.00
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.00
|
| Rate for Payer: Cigna of CA HMO |
$10,500.00
|
| Rate for Payer: Cigna of CA PPO |
$10,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,445.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,500.00
|
| Rate for Payer: Multiplan Commercial |
$11,250.00
|
| Rate for Payer: Networks By Design Commercial |
$7,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.00
|
| Rate for Payer: Riverside University Health System MISP |
$6,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.00
|
|
