|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
905355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,217.32 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$1,523.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,981.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.37
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,900.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,099.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$1,858.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
915355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,217.32 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$1,523.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,787.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,162.18
|
| Rate for Payer: Blue Shield of California Commercial |
$2,981.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.37
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,159.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,900.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,099.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,601.90
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$1,858.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
905355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,981.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.37
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
915355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Adventist Health Commercial |
$743.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,981.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.37
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,360.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,193.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$2,416.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,394.99
|
| Rate for Payer: United Healthcare All Other HMO |
$1,357.82
|
| Rate for Payer: United Healthcare HMO Rider |
$1,328.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.32
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
OP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
905355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,356.83 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$1,698.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,278.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,409.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,322.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,521.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,521.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,831.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,630.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,023.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,444.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,698.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,900.10
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,071.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,657.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,521.55
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
IP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
915355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.60 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$828.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,322.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,630.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,444.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.60
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,692.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
OP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
915355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,356.83 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$1,698.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,278.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,409.98
|
| Rate for Payer: Blue Shield of California Commercial |
$3,322.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,521.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,521.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,831.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,630.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,023.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,444.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,698.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,900.10
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,071.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,657.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,521.55
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
IP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
905355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.60 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$828.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,322.69
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,630.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,444.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.60
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,692.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
915355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$397.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,262.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,172.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$1,292.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
905355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$651.07 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$815.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,156.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,689.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,262.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,575.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,172.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,391.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Riverside University Health System MISP |
$795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
915355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$651.07 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Adventist Health Commercial |
$815.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,156.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,689.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,262.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,575.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,172.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,391.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Riverside University Health System MISP |
$795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
905355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$397.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,594.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,262.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,172.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$1,292.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,337.40 |
| Rate for Payer: Adventist Health Commercial |
$297.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.77
|
| Rate for Payer: Blue Shield of California EPN |
$748.94
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$943.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$965.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$557.70
|
| Rate for Payer: United Healthcare All Other HMO |
$542.84
|
| Rate for Payer: United Healthcare HMO Rider |
$531.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.67
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
IP
|
$3,772.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
915355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$754.40 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,025.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,901.09
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: Cigna of CA HMO |
$2,640.40
|
| Rate for Payer: Cigna of CA PPO |
$2,640.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,640.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,395.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,225.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.33
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
OP
|
$3,772.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
915355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,235.33 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Adventist Health Commercial |
$1,546.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,074.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,829.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,194.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,025.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,901.09
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Cash Price |
$1,697.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: Cigna of CA HMO |
$2,640.40
|
| Rate for Payer: Cigna of CA PPO |
$2,640.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,206.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,206.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,640.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,351.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,395.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,492.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,225.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,640.40
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$1,886.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,508.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,263.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,263.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,206.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,206.20
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.67 |
| Max. Negotiated Rate |
$1,492.94 |
| Rate for Payer: Adventist Health Commercial |
$609.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,114.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$864.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.77
|
| Rate for Payer: Blue Shield of California EPN |
$748.94
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,263.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,351.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$943.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,492.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,040.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$743.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: Riverside University Health System MISP |
$594.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$557.70
|
| Rate for Payer: United Healthcare All Other HMO |
$542.84
|
| Rate for Payer: United Healthcare HMO Rider |
$531.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.10
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$1,047.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,200.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,325.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,089.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,047.40
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$3,404.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,715.12 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$2,147.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,927.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,046.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,200.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,451.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,363.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,325.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,089.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,665.90
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,094.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.45
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$1,047.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,200.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,325.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,089.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,047.40
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$3,404.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,715.12 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$2,147.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,927.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,046.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,200.07
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,451.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,363.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,325.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,089.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,665.90
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,094.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.45
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
915355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.22 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Adventist Health Commercial |
$429.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.62
|
| Rate for Payer: Blue Shield of California Commercial |
$840.50
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$618.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Riverside University Health System MISP |
$419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Blue Shield of California Commercial |
$840.50
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$618.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.22 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$429.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.62
|
| Rate for Payer: Blue Shield of California Commercial |
$840.50
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$618.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Riverside University Health System MISP |
$419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
915355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Blue Shield of California Commercial |
$840.50
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$665.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$618.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
915355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$1,254.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,030.95
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,983.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,701.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.60
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$4,077.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
|
