|
HC BK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
915355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Adventist Health Commercial |
$419.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,681.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,677.60
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,467.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,887.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,331.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,237.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.40
|
| Rate for Payer: Multiplan Commercial |
$1,572.75
|
| Rate for Payer: Networks By Design Commercial |
$1,363.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
905355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$686.77 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Adventist Health Commercial |
$859.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,153.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,572.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,219.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,681.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,677.60
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,782.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,782.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,467.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,887.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,649.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,331.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,822.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,237.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,467.90
|
| Rate for Payer: Multiplan Commercial |
$1,572.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: Riverside University Health System MISP |
$838.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,258.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,782.45
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
915355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$686.77 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,782.45
|
| Rate for Payer: Adventist Health Commercial |
$859.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,153.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,572.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,219.82
|
| Rate for Payer: Blue Shield of California Commercial |
$1,681.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,056.89
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,677.60
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,782.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,467.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,887.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,649.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,331.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,822.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,237.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,467.90
|
| Rate for Payer: Multiplan Commercial |
$1,572.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: Riverside University Health System MISP |
$838.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,258.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,782.45
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
905355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Blue Shield of California Commercial |
$612.73
|
| Rate for Payer: Blue Shield of California EPN |
$385.06
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
915355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$702.11 |
| Rate for Payer: Adventist Health Commercial |
$313.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$420.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$573.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.42
|
| Rate for Payer: Blue Shield of California Commercial |
$612.73
|
| Rate for Payer: Blue Shield of California EPN |
$385.06
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$649.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$649.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$649.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$635.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$702.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$534.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Riverside University Health System MISP |
$305.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$649.40
|
| Rate for Payer: Vantage Medical Group Senior |
$649.40
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
915355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Blue Shield of California Commercial |
$612.73
|
| Rate for Payer: Blue Shield of California EPN |
$385.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
905355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$702.11 |
| Rate for Payer: Adventist Health Commercial |
$313.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$420.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$573.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$444.42
|
| Rate for Payer: Blue Shield of California Commercial |
$612.73
|
| Rate for Payer: Blue Shield of California EPN |
$385.06
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$649.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$649.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$649.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$635.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$702.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$450.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$534.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Riverside University Health System MISP |
$305.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$649.40
|
| Rate for Payer: Vantage Medical Group Senior |
$649.40
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
905355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$701.75
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
915355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.56 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.99
|
| Rate for Payer: Blue Shield of California Commercial |
$701.75
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$349.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Riverside University Health System MISP |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
915355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$701.75
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
905355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.56 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.99
|
| Rate for Payer: Blue Shield of California Commercial |
$701.75
|
| Rate for Payer: Blue Shield of California EPN |
$441.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$349.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$555.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Riverside University Health System MISP |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC BK ADD LATEX SUSPENSION SLEEVE
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
905355674
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
|
|
HC BK ADD LATEX SUSPENSION SLEEVE
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
905355674
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.84
|
| Rate for Payer: Blue Shield of California Commercial |
$157.87
|
| Rate for Payer: Blue Shield of California EPN |
$99.35
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$159.36
|
| Rate for Payer: Cigna of CA PPO |
$184.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$161.85
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health System MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC BK ADD LATEX SUSP SLEEVE HVY D
|
Facility
|
IP
|
$187.00
|
|
| Hospital Charge Code |
905355675
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
|
|
HC BK ADD LATEX SUSP SLEEVE HVY D
|
Facility
|
OP
|
$187.00
|
|
| Hospital Charge Code |
905355675
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$37.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$90.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.78
|
| Rate for Payer: Blue Shield of California Commercial |
$118.56
|
| Rate for Payer: Blue Shield of California EPN |
$74.61
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$149.60
|
| Rate for Payer: Cigna of CA HMO |
$119.68
|
| Rate for Payer: Cigna of CA PPO |
$138.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$158.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$158.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$158.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.80
|
| Rate for Payer: EPIC Health Plan Senior |
$74.80
|
| Rate for Payer: Galaxy Health WC |
$158.95
|
| Rate for Payer: Global Benefits Group Commercial |
$112.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$168.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$130.90
|
| Rate for Payer: Multiplan Commercial |
$140.25
|
| Rate for Payer: Networks By Design Commercial |
$121.55
|
| Rate for Payer: Prime Health Services Commercial |
$158.95
|
| Rate for Payer: Riverside University Health System MISP |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$112.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other HMO |
$93.50
|
| Rate for Payer: United Healthcare HMO Rider |
$93.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$158.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Vantage Medical Group Senior |
$158.95
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
905355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.79
|
| Rate for Payer: Blue Shield of California Commercial |
$184.46
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
915355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.79
|
| Rate for Payer: Blue Shield of California Commercial |
$184.46
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
915355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Blue Shield of California Commercial |
$184.46
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
905355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Blue Shield of California Commercial |
$184.46
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
905355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.03
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
915355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
915355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.03
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
905355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
915355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$480.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$682.33
|
| Rate for Payer: Blue Shield of California Commercial |
$940.75
|
| Rate for Payer: Blue Shield of California EPN |
$591.19
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$674.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$745.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$821.10
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Riverside University Health System MISP |
$469.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.23
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$419.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
|
OP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
905355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$480.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$682.33
|
| Rate for Payer: Blue Shield of California Commercial |
$940.75
|
| Rate for Payer: Blue Shield of California EPN |
$591.19
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$674.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$744.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$745.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$692.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$821.10
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Riverside University Health System MISP |
$469.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.23
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$419.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
