|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
915355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Blue Shield of California Commercial |
$988.87
|
| Rate for Payer: Blue Shield of California EPN |
$621.43
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$782.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$727.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.74
|
| Rate for Payer: United Healthcare All Other HMO |
$450.41
|
| Rate for Payer: United Healthcare HMO Rider |
$440.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.81
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
905355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$293.11 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$366.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$671.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.62
|
| Rate for Payer: Blue Shield of California Commercial |
$717.79
|
| Rate for Payer: Blue Shield of California EPN |
$451.08
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$760.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$760.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$626.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$333.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$568.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$528.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$626.50
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: Riverside University Health System MISP |
$358.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$760.75
|
| Rate for Payer: Vantage Medical Group Senior |
$760.75
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
915355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$293.11 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$366.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$671.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.62
|
| Rate for Payer: Blue Shield of California Commercial |
$717.79
|
| Rate for Payer: Blue Shield of California EPN |
$451.08
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$760.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$760.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$626.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$333.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$568.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$528.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$626.50
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: Riverside University Health System MISP |
$358.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$760.75
|
| Rate for Payer: Vantage Medical Group Senior |
$760.75
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
905355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$179.00
|
| Rate for Payer: Blue Shield of California Commercial |
$717.79
|
| Rate for Payer: Blue Shield of California EPN |
$451.08
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$626.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$568.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$528.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.00
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$581.75
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
915355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Adventist Health Commercial |
$179.00
|
| Rate for Payer: Blue Shield of California Commercial |
$717.79
|
| Rate for Payer: Blue Shield of California EPN |
$451.08
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$626.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Senior |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$568.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$528.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.00
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$581.75
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$335.89
|
| Rate for Payer: United Healthcare All Other HMO |
$326.94
|
| Rate for Payer: United Healthcare HMO Rider |
$319.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.11
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
905355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.60 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Adventist Health Commercial |
$628.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,520.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,584.07
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,514.40
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,200.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,828.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,995.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,854.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.60
|
| Rate for Payer: Multiplan Commercial |
$2,357.25
|
| Rate for Payer: Networks By Design Commercial |
$2,042.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
915355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,029.33 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Adventist Health Commercial |
$1,288.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,728.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,357.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,828.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,520.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,584.07
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,514.40
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,671.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,671.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,200.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,828.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,207.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,995.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,333.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,854.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,200.10
|
| Rate for Payer: Multiplan Commercial |
$2,357.25
|
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,257.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,885.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,885.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,671.55
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
905355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,029.33 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Adventist Health Commercial |
$1,288.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,728.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,357.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,828.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,520.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,584.07
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,514.40
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,671.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,671.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,200.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,828.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,207.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,995.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,333.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,854.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,200.10
|
| Rate for Payer: Multiplan Commercial |
$2,357.25
|
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,257.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,885.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,885.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,671.55
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
915355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.60 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Adventist Health Commercial |
$628.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,520.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,584.07
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,514.40
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,200.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,828.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,995.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,854.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.60
|
| Rate for Payer: Multiplan Commercial |
$2,357.25
|
| Rate for Payer: Networks By Design Commercial |
$2,042.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,148.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,123.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,029.33
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
905355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$170.96 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$214.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$391.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.65
|
| Rate for Payer: Blue Shield of California Commercial |
$418.64
|
| Rate for Payer: Blue Shield of California EPN |
$263.09
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$365.40
|
| Rate for Payer: Cigna of CA PPO |
$365.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$443.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$365.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$331.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$365.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$261.00
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Riverside University Health System MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.91
|
| Rate for Payer: United Healthcare All Other HMO |
$190.69
|
| Rate for Payer: United Healthcare HMO Rider |
$186.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
915355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$842.10
|
| Rate for Payer: Blue Shield of California EPN |
$529.20
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Central Health Plan Commercial |
$840.00
|
| Rate for Payer: Cigna of CA HMO |
$735.00
|
| Rate for Payer: Cigna of CA PPO |
$735.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$666.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$619.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.06
|
| Rate for Payer: United Healthcare All Other HMO |
$383.56
|
| Rate for Payer: United Healthcare HMO Rider |
$375.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.88
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
905355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Blue Shield of California Commercial |
$418.64
|
| Rate for Payer: Blue Shield of California EPN |
$263.09
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$365.40
|
| Rate for Payer: Cigna of CA PPO |
$365.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$365.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$331.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$307.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.91
|
| Rate for Payer: United Healthcare All Other HMO |
$190.69
|
| Rate for Payer: United Healthcare HMO Rider |
$186.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.96
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
915355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.88 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Adventist Health Commercial |
$430.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$577.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$787.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$610.78
|
| Rate for Payer: Blue Shield of California Commercial |
$842.10
|
| Rate for Payer: Blue Shield of California EPN |
$529.20
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Central Health Plan Commercial |
$840.00
|
| Rate for Payer: Cigna of CA HMO |
$735.00
|
| Rate for Payer: Cigna of CA PPO |
$735.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$892.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$892.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$892.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$359.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$666.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$396.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$619.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$430.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
| Rate for Payer: Networks By Design Commercial |
$525.00
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Riverside University Health System MISP |
$420.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.06
|
| Rate for Payer: United Healthcare All Other HMO |
$383.56
|
| Rate for Payer: United Healthcare HMO Rider |
$375.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$892.50
|
| Rate for Payer: Vantage Medical Group Senior |
$892.50
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
915355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$2,183.40 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,945.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.80
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,698.20
|
| 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: Health Management Network EPO/PPO |
$2,183.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,540.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,431.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.20
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
| Rate for Payer: Networks By Design Commercial |
$1,576.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
905355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$794.51 |
| Max. Negotiated Rate |
$2,183.40 |
| Rate for Payer: Adventist Health Commercial |
$994.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,334.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,819.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,411.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,945.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.80
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,062.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,062.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,698.20
|
| 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: Health Management Network EPO/PPO |
$2,183.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,540.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,430.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,431.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,698.20
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: Riverside University Health System MISP |
$970.40
|
| 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 |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,062.10
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
905355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$2,183.40 |
| Rate for Payer: Adventist Health Commercial |
$485.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,945.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.80
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,698.20
|
| 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: Health Management Network EPO/PPO |
$2,183.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,540.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,431.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.20
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
| Rate for Payer: Networks By Design Commercial |
$1,576.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
915355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$794.51 |
| Max. Negotiated Rate |
$2,183.40 |
| Rate for Payer: Adventist Health Commercial |
$994.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,334.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,819.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,411.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,945.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.80
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,062.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,062.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,698.20
|
| 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: Health Management Network EPO/PPO |
$2,183.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,540.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,430.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,431.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,698.20
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: Riverside University Health System MISP |
$970.40
|
| 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 |
$910.48
|
| Rate for Payer: United Healthcare All Other HMO |
$886.22
|
| Rate for Payer: United Healthcare HMO Rider |
$867.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,062.10
|
|
|
HC AK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5460
|
| Hospital Charge Code |
905355460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$283.16 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.99
|
| Rate for Payer: Blue Shield of California Commercial |
$701.75
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$283.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Riverside University Health System MISP |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC AK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$998.00
|
|
|
Service Code
|
CPT L5460
|
| Hospital Charge Code |
915355460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$199.60 |
| Max. Negotiated Rate |
$898.20 |
| Rate for Payer: Adventist Health Commercial |
$199.60
|
| Rate for Payer: Blue Shield of California Commercial |
$800.40
|
| Rate for Payer: Blue Shield of California EPN |
$502.99
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Central Health Plan Commercial |
$798.40
|
| Rate for Payer: Cigna of CA HMO |
$698.60
|
| Rate for Payer: Cigna of CA PPO |
$698.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$698.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$399.20
|
| Rate for Payer: Galaxy Health WC |
$848.30
|
| Rate for Payer: Global Benefits Group Commercial |
$598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$898.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$588.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.60
|
| Rate for Payer: Multiplan Commercial |
$748.50
|
| Rate for Payer: Networks By Design Commercial |
$648.70
|
| Rate for Payer: Prime Health Services Commercial |
$848.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$374.55
|
| Rate for Payer: United Healthcare All Other HMO |
$364.57
|
| Rate for Payer: United Healthcare HMO Rider |
$356.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.85
|
|
|
HC AK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT L5460
|
| Hospital Charge Code |
905355460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$701.75
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
|
|
HC AK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$998.00
|
|
|
Service Code
|
CPT L5460
|
| Hospital Charge Code |
915355460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$283.16 |
| Max. Negotiated Rate |
$898.20 |
| Rate for Payer: Adventist Health Commercial |
$409.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$848.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$748.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$580.54
|
| Rate for Payer: Blue Shield of California Commercial |
$800.40
|
| Rate for Payer: Blue Shield of California EPN |
$502.99
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Central Health Plan Commercial |
$798.40
|
| Rate for Payer: Cigna of CA HMO |
$698.60
|
| Rate for Payer: Cigna of CA PPO |
$698.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$848.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$848.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$698.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$399.20
|
| Rate for Payer: EPIC Health Plan Senior |
$399.20
|
| Rate for Payer: Galaxy Health WC |
$848.30
|
| Rate for Payer: Global Benefits Group Commercial |
$598.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$898.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$283.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$633.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$588.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$698.60
|
| Rate for Payer: Multiplan Commercial |
$748.50
|
| Rate for Payer: Networks By Design Commercial |
$499.00
|
| Rate for Payer: Prime Health Services Commercial |
$848.30
|
| Rate for Payer: Riverside University Health System MISP |
$399.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$598.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$598.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$374.55
|
| Rate for Payer: United Healthcare All Other HMO |
$364.57
|
| Rate for Payer: United Healthcare HMO Rider |
$356.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$848.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$848.30
|
| Rate for Payer: Vantage Medical Group Senior |
$848.30
|
|
|
HC AK MLD SKT OPN END ENDOSKELETL
|
Facility
|
IP
|
$12,870.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,574.00 |
| Max. Negotiated Rate |
$11,583.00 |
| Rate for Payer: Adventist Health Commercial |
$2,574.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,321.74
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,296.00
|
| Rate for Payer: Cigna of CA HMO |
$9,009.00
|
| Rate for Payer: Cigna of CA PPO |
$9,009.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,009.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,148.00
|
| Rate for Payer: Galaxy Health WC |
$10,939.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,722.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,583.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,172.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,593.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,574.00
|
| Rate for Payer: Multiplan Commercial |
$9,652.50
|
| Rate for Payer: Networks By Design Commercial |
$8,365.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,939.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,701.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4,599.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,214.93
|
|
|
HC AK MLD SKT OPN END ENDOSKELETL
|
Facility
|
IP
|
$12,870.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,574.00 |
| Max. Negotiated Rate |
$11,583.00 |
| Rate for Payer: Adventist Health Commercial |
$2,574.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,321.74
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,296.00
|
| Rate for Payer: Cigna of CA HMO |
$9,009.00
|
| Rate for Payer: Cigna of CA PPO |
$9,009.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,009.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,148.00
|
| Rate for Payer: Galaxy Health WC |
$10,939.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,722.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,583.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,172.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,593.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,574.00
|
| Rate for Payer: Multiplan Commercial |
$9,652.50
|
| Rate for Payer: Networks By Design Commercial |
$8,365.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,939.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,701.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4,599.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,214.93
|
|
|
HC AK MLD SKT OPN END ENDOSKELETL
|
Facility
|
OP
|
$12,870.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,214.93 |
| Max. Negotiated Rate |
$11,583.00 |
| Rate for Payer: Adventist Health Commercial |
$5,276.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,078.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,486.48
|
| Rate for Payer: Blue Shield of California Commercial |
$10,321.74
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,296.00
|
| Rate for Payer: Cigna of CA HMO |
$9,009.00
|
| Rate for Payer: Cigna of CA PPO |
$9,009.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,939.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,939.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,009.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,148.00
|
| Rate for Payer: Galaxy Health WC |
$10,939.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,722.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,583.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,835.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,172.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,593.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,276.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,009.00
|
| Rate for Payer: Multiplan Commercial |
$9,652.50
|
| Rate for Payer: Networks By Design Commercial |
$6,435.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,939.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,722.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,722.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,701.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4,599.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,214.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,939.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,939.50
|
|
|
HC AK MLD SKT OPN END ENDOSKELETL
|
Facility
|
OP
|
$12,870.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,214.93 |
| Max. Negotiated Rate |
$11,583.00 |
| Rate for Payer: Adventist Health Commercial |
$5,276.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,078.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,652.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,486.48
|
| Rate for Payer: Blue Shield of California Commercial |
$10,321.74
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Cash Price |
$5,791.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,296.00
|
| Rate for Payer: Cigna of CA HMO |
$9,009.00
|
| Rate for Payer: Cigna of CA PPO |
$9,009.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,939.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,939.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,009.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,148.00
|
| Rate for Payer: Galaxy Health WC |
$10,939.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,722.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,583.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,835.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,172.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,593.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,276.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,009.00
|
| Rate for Payer: Multiplan Commercial |
$9,652.50
|
| Rate for Payer: Networks By Design Commercial |
$6,435.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,939.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,722.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,722.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,830.11
|
| Rate for Payer: United Healthcare All Other HMO |
$4,701.41
|
| Rate for Payer: United Healthcare HMO Rider |
$4,599.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,214.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,939.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,939.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,939.50
|
|
