|
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 |
$1,424.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,875.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.70
|
| Rate for Payer: Cash Price |
$1,334.30
|
| Rate for Payer: Cash Price |
$1,334.30
|
| 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: 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: InnovAge PACE Commercial |
$1,213.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,430.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,698.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$1,424.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,875.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.70
|
| Rate for Payer: Cash Price |
$1,334.30
|
| Rate for Payer: Cash Price |
$1,334.30
|
| 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: 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: InnovAge PACE Commercial |
$1,213.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,430.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,501.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,698.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
$513.89
|
| Rate for Payer: Blue Shield of California Commercial |
$676.38
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$481.25
|
| Rate for Payer: Cash Price |
$481.25
|
| 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: 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: InnovAge PACE Commercial |
$437.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
$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 |
$676.38
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$481.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| 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
|
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 |
$771.45
|
| Rate for Payer: Blue Shield of California EPN |
$502.99
|
| Rate for Payer: Cash Price |
$548.90
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$665.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$380.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$617.76
|
| 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
|
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 |
$586.13
|
| Rate for Payer: Blue Shield of California Commercial |
$771.45
|
| Rate for Payer: Blue Shield of California EPN |
$502.99
|
| Rate for Payer: Cash Price |
$548.90
|
| Rate for Payer: Cash Price |
$548.90
|
| 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: 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: InnovAge PACE Commercial |
$499.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$665.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$617.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$698.60
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$9,948.51
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$7,078.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$8,584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,903.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,966.53
|
| 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 |
$7,558.55
|
| Rate for Payer: Blue Shield of California Commercial |
$9,948.51
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$7,078.50
|
| Rate for Payer: Cash Price |
$7,078.50
|
| 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: 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: InnovAge PACE Commercial |
$6,435.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,966.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,276.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,009.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$9,948.51
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$7,078.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$8,584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,903.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,966.53
|
| 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 |
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 |
$7,558.55
|
| Rate for Payer: Blue Shield of California Commercial |
$9,948.51
|
| Rate for Payer: Blue Shield of California EPN |
$6,486.48
|
| Rate for Payer: Cash Price |
$7,078.50
|
| Rate for Payer: Cash Price |
$7,078.50
|
| 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: 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: InnovAge PACE Commercial |
$6,435.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,966.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,276.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,009.00
|
| Rate for Payer: Molina Healthcare of CA 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 PFFD SACH FOOT
|
Facility
|
IP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,376.80 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Adventist Health Commercial |
$2,376.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,186.33
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$6,536.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,926.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,527.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,356.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,376.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$7,724.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
IP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
915355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,376.80 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Adventist Health Commercial |
$2,376.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,186.33
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$6,536.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,926.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,527.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,356.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,376.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$7,724.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
OP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,892.01 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,536.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,913.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,979.47
|
| Rate for Payer: Blue Shield of California Commercial |
$9,186.33
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$6,536.20
|
| Rate for Payer: Cash Price |
$6,536.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,101.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,101.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,147.57
|
| Rate for Payer: InnovAge PACE Commercial |
$5,942.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,926.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,581.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,356.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,318.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,318.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,753.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,130.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,101.40
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
OP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
915355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,892.01 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Adventist Health Commercial |
$4,872.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,536.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,913.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,979.47
|
| Rate for Payer: Blue Shield of California Commercial |
$9,186.33
|
| Rate for Payer: Blue Shield of California EPN |
$5,989.54
|
| Rate for Payer: Cash Price |
$6,536.20
|
| Rate for Payer: Cash Price |
$6,536.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,101.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,101.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,147.57
|
| Rate for Payer: InnovAge PACE Commercial |
$5,942.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,926.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,581.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,356.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,318.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,318.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,753.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,130.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,460.07
|
| Rate for Payer: United Healthcare All Other HMO |
$4,341.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4,247.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,892.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,101.40
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
915355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$799.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,091.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$2,199.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,667.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,523.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,475.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.80
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$2,599.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
915355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,309.67 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$1,639.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,199.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,999.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,348.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,091.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$2,199.45
|
| Rate for Payer: Cash Price |
$2,199.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,399.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,399.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,159.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,999.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,667.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,475.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,799.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,799.30
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,599.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,399.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,399.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,399.15
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$799.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,091.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$2,199.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,667.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,523.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,475.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.80
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$2,599.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,309.67 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Adventist Health Commercial |
$1,639.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,199.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,999.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,348.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,091.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.50
|
| Rate for Payer: Cash Price |
$2,199.45
|
| Rate for Payer: Cash Price |
$2,199.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,399.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,399.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,159.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,999.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,667.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,475.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,799.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,799.30
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,599.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,399.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,399.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,500.82
|
| Rate for Payer: United Healthcare All Other HMO |
$1,460.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,429.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,309.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,399.15
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
IP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
915355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.20 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$1,028.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,973.99
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,827.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,958.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,182.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.20
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$3,341.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
OP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,683.68 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$2,107.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,827.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,855.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,019.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,973.99
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,827.55
|
| Rate for Payer: Cash Price |
$2,827.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,369.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,157.81
|
| Rate for Payer: InnovAge PACE Commercial |
$2,570.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,383.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,182.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,598.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,598.70
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,056.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,084.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.85
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
OP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
915355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,683.68 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$2,107.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,827.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,855.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,019.31
|
| Rate for Payer: Blue Shield of California Commercial |
$3,973.99
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,827.55
|
| Rate for Payer: Cash Price |
$2,827.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,369.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,369.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,157.81
|
| Rate for Payer: InnovAge PACE Commercial |
$2,570.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,383.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,182.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,598.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,598.70
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,056.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,084.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.85
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
IP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.20 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Adventist Health Commercial |
$1,028.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,973.99
|
| Rate for Payer: Blue Shield of California EPN |
$2,591.06
|
| Rate for Payer: Cash Price |
$2,827.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,958.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,182.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.20
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$3,341.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,929.42
|
| Rate for Payer: United Healthcare All Other HMO |
$1,878.01
|
| Rate for Payer: United Healthcare HMO Rider |
$1,837.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.68
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
915355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.40 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Adventist Health Commercial |
$1,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,256.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.53
|
| Rate for Payer: Cash Price |
$3,028.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,673.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,098.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.40
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$3,579.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.40 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Adventist Health Commercial |
$1,101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,256.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.53
|
| Rate for Payer: Cash Price |
$3,028.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,673.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,098.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.40
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$3,579.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
915355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,803.54 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Adventist Health Commercial |
$2,257.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,028.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,130.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,234.26
|
| Rate for Payer: Blue Shield of California Commercial |
$4,256.91
|
| Rate for Payer: Blue Shield of California EPN |
$2,775.53
|
| Rate for Payer: Cash Price |
$3,028.85
|
| Rate for Payer: Cash Price |
$3,028.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,680.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,680.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,567.62
|
| Rate for Payer: InnovAge PACE Commercial |
$2,753.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,673.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,836.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,408.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,854.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,854.90
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$2,753.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: Riverside University Health System MISP |
$2,202.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,066.78
|
| Rate for Payer: United Healthcare All Other HMO |
$2,011.71
|
| Rate for Payer: United Healthcare HMO Rider |
$1,968.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,803.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,680.95
|
|
