|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
915355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$549.90 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Blue Shield of California Commercial |
$472.30
|
| Rate for Payer: Blue Shield of California EPN |
$307.94
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Central Health Plan Commercial |
$488.80
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.20
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: Networks By Design Commercial |
$397.15
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other HMO |
$223.20
|
| Rate for Payer: United Healthcare HMO Rider |
$218.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.10
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
905355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$549.90 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Blue Shield of California Commercial |
$472.30
|
| Rate for Payer: Blue Shield of California EPN |
$307.94
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Central Health Plan Commercial |
$488.80
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.20
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: Networks By Design Commercial |
$397.15
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other HMO |
$223.20
|
| Rate for Payer: United Healthcare HMO Rider |
$218.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.10
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
|
OP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
915355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$549.90 |
| Rate for Payer: Adventist Health Commercial |
$250.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$519.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$458.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$358.84
|
| Rate for Payer: Blue Shield of California Commercial |
$472.30
|
| Rate for Payer: Blue Shield of California EPN |
$307.94
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Cash Price |
$336.05
|
| Rate for Payer: Central Health Plan Commercial |
$488.80
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$519.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$519.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$519.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.20
|
| Rate for Payer: InnovAge PACE Commercial |
$305.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.70
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: Riverside University Health System MISP |
$244.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.31
|
| Rate for Payer: United Healthcare All Other HMO |
$223.20
|
| Rate for Payer: United Healthcare HMO Rider |
$218.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$519.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$519.35
|
| Rate for Payer: Vantage Medical Group Senior |
$519.35
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
915355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$142.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$268.23
|
| Rate for Payer: Blue Shield of California EPN |
$174.89
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$201.33
|
| Rate for Payer: InnovAge PACE Commercial |
$173.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.90
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Riverside University Health System MISP |
$138.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
905355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$142.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$268.23
|
| Rate for Payer: Blue Shield of California EPN |
$174.89
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$201.33
|
| Rate for Payer: InnovAge PACE Commercial |
$173.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.90
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Riverside University Health System MISP |
$138.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
915355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$268.23
|
| Rate for Payer: Blue Shield of California EPN |
$174.89
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
905355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$268.23
|
| Rate for Payer: Blue Shield of California EPN |
$174.89
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
905355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Blue Shield of California Commercial |
$548.83
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
915355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.79 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.98
|
| Rate for Payer: Blue Shield of California Commercial |
$548.83
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.79
|
| Rate for Payer: InnovAge PACE Commercial |
$355.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Riverside University Health System MISP |
$284.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
915355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$142.00
|
| Rate for Payer: Blue Shield of California Commercial |
$548.83
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$461.50
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
905355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.79 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Adventist Health Commercial |
$291.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$532.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$416.98
|
| Rate for Payer: Blue Shield of California Commercial |
$548.83
|
| Rate for Payer: Blue Shield of California EPN |
$357.84
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Cash Price |
$390.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$603.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Senior |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.79
|
| Rate for Payer: InnovAge PACE Commercial |
$355.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$439.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Riverside University Health System MISP |
$284.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.46
|
| Rate for Payer: United Healthcare All Other HMO |
$259.36
|
| Rate for Payer: United Healthcare HMO Rider |
$253.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
905355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$377.61 |
| Max. Negotiated Rate |
$1,037.70 |
| Rate for Payer: Adventist Health Commercial |
$472.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$634.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$677.16
|
| Rate for Payer: Blue Shield of California Commercial |
$891.27
|
| Rate for Payer: Blue Shield of California EPN |
$581.11
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Central Health Plan Commercial |
$922.40
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$980.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$980.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$980.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,037.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$428.07
|
| Rate for Payer: InnovAge PACE Commercial |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$807.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$807.10
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: Riverside University Health System MISP |
$461.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$980.05
|
| Rate for Payer: Vantage Medical Group Senior |
$980.05
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
915355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$377.61 |
| Max. Negotiated Rate |
$1,037.70 |
| Rate for Payer: Adventist Health Commercial |
$472.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$634.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$677.16
|
| Rate for Payer: Blue Shield of California Commercial |
$891.27
|
| Rate for Payer: Blue Shield of California EPN |
$581.11
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Central Health Plan Commercial |
$922.40
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$980.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$980.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$980.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,037.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$428.07
|
| Rate for Payer: InnovAge PACE Commercial |
$576.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$807.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$807.10
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: Riverside University Health System MISP |
$461.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$980.05
|
| Rate for Payer: Vantage Medical Group Senior |
$980.05
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
905355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$1,037.70 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Blue Shield of California Commercial |
$891.27
|
| Rate for Payer: Blue Shield of California EPN |
$581.11
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Central Health Plan Commercial |
$922.40
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,037.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.60
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: Networks By Design Commercial |
$749.45
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
915355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$1,037.70 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Blue Shield of California Commercial |
$891.27
|
| Rate for Payer: Blue Shield of California EPN |
$581.11
|
| Rate for Payer: Cash Price |
$634.15
|
| Rate for Payer: Central Health Plan Commercial |
$922.40
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Senior |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,037.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$439.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$713.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.60
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: Networks By Design Commercial |
$749.45
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$432.72
|
| Rate for Payer: United Healthcare All Other HMO |
$421.19
|
| Rate for Payer: United Healthcare HMO Rider |
$412.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.61
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
905355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| 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 HMO/PPO |
$146.24
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| 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: 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: Inland Empire Health Plan (IEHP) medi-cal |
$130.03
|
| Rate for Payer: InnovAge PACE Commercial |
$124.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| 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 |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| 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 WAIST BELT PAD & LINED
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
915355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.01 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Adventist Health Commercial |
$116.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$166.79
|
| Rate for Payer: Blue Shield of California Commercial |
$219.53
|
| Rate for Payer: Blue Shield of California EPN |
$143.14
|
| Rate for Payer: Cash Price |
$156.20
|
| Rate for Payer: Cash Price |
$156.20
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: Cigna of CA HMO |
$198.80
|
| Rate for Payer: Cigna of CA PPO |
$198.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.03
|
| Rate for Payer: InnovAge PACE Commercial |
$142.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.80
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Networks By Design Commercial |
$142.00
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Riverside University Health System MISP |
$113.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.59
|
| Rate for Payer: United Healthcare All Other HMO |
$103.75
|
| Rate for Payer: United Healthcare HMO Rider |
$101.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
915355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Blue Shield of California Commercial |
$219.53
|
| Rate for Payer: Blue Shield of California EPN |
$143.14
|
| Rate for Payer: Cash Price |
$156.20
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: Cigna of CA HMO |
$198.80
|
| Rate for Payer: Cigna of CA PPO |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$175.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.59
|
| Rate for Payer: United Healthcare All Other HMO |
$103.75
|
| Rate for Payer: United Healthcare HMO Rider |
$101.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$93.01
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
|
IP
|
$249.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
905355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Adventist Health Commercial |
$49.80
|
| Rate for Payer: Blue Shield of California Commercial |
$192.48
|
| Rate for Payer: Blue Shield of California EPN |
$125.50
|
| Rate for Payer: Cash Price |
$136.95
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$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 Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.13
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
OP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
915355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$811.54 |
| Max. Negotiated Rate |
$2,230.20 |
| Rate for Payer: Adventist Health Commercial |
$1,015.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,362.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,858.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,455.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,915.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,248.91
|
| Rate for Payer: Cash Price |
$1,362.90
|
| Rate for Payer: Cash Price |
$1,362.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,982.40
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,106.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,106.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,230.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$998.74
|
| Rate for Payer: InnovAge PACE Commercial |
$1,239.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,103.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,734.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,734.60
|
| Rate for Payer: Multiplan Commercial |
$1,858.50
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: Riverside University Health System MISP |
$991.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,486.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,486.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,106.30
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
IP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
905355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$495.60 |
| Max. Negotiated Rate |
$2,230.20 |
| Rate for Payer: Adventist Health Commercial |
$495.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,915.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,248.91
|
| Rate for Payer: Cash Price |
$1,362.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,982.40
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,230.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$944.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.60
|
| Rate for Payer: Multiplan Commercial |
$1,858.50
|
| Rate for Payer: Networks By Design Commercial |
$1,610.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
IP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
915355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$495.60 |
| Max. Negotiated Rate |
$2,230.20 |
| Rate for Payer: Adventist Health Commercial |
$495.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,915.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,248.91
|
| Rate for Payer: Cash Price |
$1,362.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,982.40
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,230.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$944.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.60
|
| Rate for Payer: Multiplan Commercial |
$1,858.50
|
| Rate for Payer: Networks By Design Commercial |
$1,610.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
|
OP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
905355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$811.54 |
| Max. Negotiated Rate |
$2,230.20 |
| Rate for Payer: Adventist Health Commercial |
$1,015.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,362.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,858.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,455.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,915.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,248.91
|
| Rate for Payer: Cash Price |
$1,362.90
|
| Rate for Payer: Cash Price |
$1,362.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,982.40
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,106.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,106.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Senior |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,230.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$998.74
|
| Rate for Payer: InnovAge PACE Commercial |
$1,239.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,103.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,533.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,734.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,734.60
|
| Rate for Payer: Multiplan Commercial |
$1,858.50
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: Riverside University Health System MISP |
$991.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,486.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,486.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.99
|
| Rate for Payer: United Healthcare All Other HMO |
$905.21
|
| Rate for Payer: United Healthcare HMO Rider |
$885.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$811.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,106.30
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
905355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.43 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.00
|
| Rate for Payer: Blue Shield of California Commercial |
$340.89
|
| Rate for Payer: Blue Shield of California EPN |
$222.26
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$347.75
|
| Rate for Payer: InnovAge PACE Commercial |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.70
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Riverside University Health System MISP |
$176.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.51
|
| Rate for Payer: United Healthcare All Other HMO |
$161.10
|
| Rate for Payer: United Healthcare HMO Rider |
$157.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.85
|
| Rate for Payer: Vantage Medical Group Senior |
$374.85
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
915355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.43 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.00
|
| Rate for Payer: Blue Shield of California Commercial |
$340.89
|
| Rate for Payer: Blue Shield of California EPN |
$222.26
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$347.75
|
| Rate for Payer: InnovAge PACE Commercial |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.70
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Riverside University Health System MISP |
$176.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.51
|
| Rate for Payer: United Healthcare All Other HMO |
$161.10
|
| Rate for Payer: United Healthcare HMO Rider |
$157.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.85
|
| Rate for Payer: Vantage Medical Group Senior |
$374.85
|
|
