|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
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
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
915355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,013.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,646.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,729.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
915355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$871.15 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,090.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,463.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,562.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,261.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,806.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,330.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,646.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,862.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,862.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,064.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,596.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,596.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,261.00
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$871.15 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$1,090.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,463.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,562.22
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,261.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,806.40
|
| Rate for Payer: InnovAge PACE Commercial |
$1,330.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,646.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,862.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,862.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,064.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,596.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,596.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,261.00
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Adventist Health Commercial |
$532.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,056.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,340.64
|
| Rate for Payer: Cash Price |
$1,463.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,013.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,646.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,729.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$998.30
|
| Rate for Payer: United Healthcare All Other HMO |
$971.70
|
| Rate for Payer: United Healthcare HMO Rider |
$950.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.15
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,937.49 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Adventist Health Commercial |
$2,425.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,253.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,474.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,573.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$3,253.80
|
| Rate for Payer: Cash Price |
$3,253.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,028.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,028.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,008.13
|
| Rate for Payer: InnovAge PACE Commercial |
$2,958.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,141.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,366.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,028.60
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Adventist Health Commercial |
$1,183.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,573.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$3,253.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,254.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$3,845.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
915355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,937.49 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Adventist Health Commercial |
$2,425.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,253.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,437.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,474.47
|
| Rate for Payer: Blue Shield of California Commercial |
$4,573.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$3,253.80
|
| Rate for Payer: Cash Price |
$3,253.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,028.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,028.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,008.13
|
| Rate for Payer: InnovAge PACE Commercial |
$2,958.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,141.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,141.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,366.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,028.60
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
915355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Adventist Health Commercial |
$1,183.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,573.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,981.66
|
| Rate for Payer: Cash Price |
$3,253.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,254.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,662.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$3,845.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,220.27
|
| Rate for Payer: United Healthcare All Other HMO |
$2,161.11
|
| Rate for Payer: United Healthcare HMO Rider |
$2,114.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,937.49
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.80 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$1,505.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,819.92
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$4,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.80
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$4,893.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,465.75 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$3,086.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,646.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,421.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5,819.92
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$4,140.95
|
| Rate for Payer: Cash Price |
$4,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,399.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,835.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,764.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,086.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,270.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,270.30
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
915355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.80 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$1,505.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,819.92
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$4,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.80
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$4,893.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,465.75 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Adventist Health Commercial |
$3,086.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,646.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,421.78
|
| Rate for Payer: Blue Shield of California Commercial |
$5,819.92
|
| Rate for Payer: Blue Shield of California EPN |
$3,794.62
|
| Rate for Payer: Cash Price |
$4,140.95
|
| Rate for Payer: Cash Price |
$4,140.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,399.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,835.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,764.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,660.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,086.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,270.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,270.30
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.63
|
| Rate for Payer: United Healthcare All Other HMO |
$2,750.34
|
| Rate for Payer: United Healthcare HMO Rider |
$2,690.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,465.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$563.30 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$705.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,010.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,329.56
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$766.35
|
| Rate for Payer: InnovAge PACE Commercial |
$860.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$846.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,204.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Riverside University Health System MISP |
$688.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
915355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,329.56
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
915355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$563.30 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$705.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,290.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,010.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,329.56
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$766.35
|
| Rate for Payer: InnovAge PACE Commercial |
$860.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$846.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,204.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,204.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: Riverside University Health System MISP |
$688.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.00
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Adventist Health Commercial |
$344.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,329.56
|
| Rate for Payer: Blue Shield of California EPN |
$866.88
|
| Rate for Payer: Cash Price |
$946.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Senior |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,064.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$1,118.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$645.52
|
| Rate for Payer: United Healthcare All Other HMO |
$628.32
|
| Rate for Payer: United Healthcare HMO Rider |
$614.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$563.30
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
915355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,550.57 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Adventist Health Commercial |
$3,193.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,283.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,841.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,573.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6,020.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Cash Price |
$4,283.40
|
| Rate for Payer: Cash Price |
$4,283.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,619.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,619.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,470.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,894.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,833.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,451.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,451.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,672.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,619.80
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
915355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Adventist Health Commercial |
$1,557.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,020.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Cash Price |
$4,283.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,967.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$5,062.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,557.60 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Adventist Health Commercial |
$1,557.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,020.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Cash Price |
$4,283.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,967.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,557.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$5,062.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
|
|
HC AK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$7,788.00
|
|
|
Service Code
|
CPT L5701
|
| Hospital Charge Code |
905355701
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,550.57 |
| Max. Negotiated Rate |
$7,009.20 |
| Rate for Payer: Adventist Health Commercial |
$3,193.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,283.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,841.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,573.89
|
| Rate for Payer: Blue Shield of California Commercial |
$6,020.12
|
| Rate for Payer: Blue Shield of California EPN |
$3,925.15
|
| Rate for Payer: Cash Price |
$4,283.40
|
| Rate for Payer: Cash Price |
$4,283.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,230.40
|
| Rate for Payer: Cigna of CA HMO |
$5,451.60
|
| Rate for Payer: Cigna of CA PPO |
$5,451.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,619.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,619.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,115.20
|
| Rate for Payer: Galaxy Health WC |
$6,619.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,672.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,009.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,470.34
|
| Rate for Payer: InnovAge PACE Commercial |
$3,894.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,833.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,820.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,451.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,451.60
|
| Rate for Payer: Multiplan Commercial |
$5,841.00
|
| Rate for Payer: Networks By Design Commercial |
$3,894.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,619.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,672.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,672.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,922.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,844.96
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,550.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,619.80
|
| Rate for Payer: Vantage Medical Group Senior |
$6,619.80
|
|
|
HC AK STUBBIES
|
Facility
|
OP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,761.62 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$2,205.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,958.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,034.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,159.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,958.45
|
| Rate for Payer: Cash Price |
$2,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,572.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,729.83
|
| Rate for Payer: InnovAge PACE Commercial |
$2,689.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,015.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,765.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,765.30
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,151.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,572.15
|
|
|
HC AK STUBBIES
|
Facility
|
IP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
915355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$1,075.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.80
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$3,496.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
|
|
HC AK STUBBIES
|
Facility
|
IP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
905355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,075.80 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$1,075.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,049.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.80
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$3,496.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
|
|
HC AK STUBBIES
|
Facility
|
OP
|
$5,379.00
|
|
|
Service Code
|
CPT L5210
|
| Hospital Charge Code |
915355210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,761.62 |
| Max. Negotiated Rate |
$4,841.10 |
| Rate for Payer: Adventist Health Commercial |
$2,205.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,958.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,034.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,159.09
|
| Rate for Payer: Blue Shield of California Commercial |
$4,157.97
|
| Rate for Payer: Blue Shield of California EPN |
$2,711.02
|
| Rate for Payer: Cash Price |
$2,958.45
|
| Rate for Payer: Cash Price |
$2,958.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,303.20
|
| Rate for Payer: Cigna of CA HMO |
$3,765.30
|
| Rate for Payer: Cigna of CA PPO |
$3,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,572.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,572.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,151.60
|
| Rate for Payer: Galaxy Health WC |
$4,572.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,227.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,841.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,729.83
|
| Rate for Payer: InnovAge PACE Commercial |
$2,689.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,587.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,015.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,329.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,765.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,765.30
|
| Rate for Payer: Multiplan Commercial |
$4,034.25
|
| Rate for Payer: Networks By Design Commercial |
$2,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,572.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,151.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,227.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,227.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,018.74
|
| Rate for Payer: United Healthcare All Other HMO |
$1,964.95
|
| Rate for Payer: United Healthcare HMO Rider |
$1,922.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,761.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,572.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,572.15
|
|
