|
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
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
905355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| 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: 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| 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
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
905355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Adventist Health Commercial |
$721.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$968.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,033.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,360.48
|
| Rate for Payer: Blue Shield of California EPN |
$887.04
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,408.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,496.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,584.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,149.05
|
| Rate for Payer: InnovAge PACE Commercial |
$880.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,269.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,232.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,232.00
|
| Rate for Payer: Multiplan Commercial |
$1,320.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: Riverside University Health System MISP |
$704.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,056.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,056.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,496.00
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
915355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$352.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Adventist Health Commercial |
$352.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,360.48
|
| Rate for Payer: Blue Shield of California EPN |
$887.04
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,408.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,584.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.00
|
| Rate for Payer: Multiplan Commercial |
$1,320.00
|
| Rate for Payer: Networks By Design Commercial |
$1,144.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
915355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Adventist Health Commercial |
$721.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$968.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,033.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,360.48
|
| Rate for Payer: Blue Shield of California EPN |
$887.04
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,408.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,496.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,584.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,149.05
|
| Rate for Payer: InnovAge PACE Commercial |
$880.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,269.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,232.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,232.00
|
| Rate for Payer: Multiplan Commercial |
$1,320.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: Riverside University Health System MISP |
$704.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,056.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,056.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,496.00
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
905355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$352.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Adventist Health Commercial |
$352.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,360.48
|
| Rate for Payer: Blue Shield of California EPN |
$887.04
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,408.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Senior |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,584.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,089.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.00
|
| Rate for Payer: Multiplan Commercial |
$1,320.00
|
| Rate for Payer: Networks By Design Commercial |
$1,144.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$660.53
|
| Rate for Payer: United Healthcare All Other HMO |
$642.93
|
| Rate for Payer: United Healthcare HMO Rider |
$629.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.40
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Adventist Health Commercial |
$130.60
|
| Rate for Payer: Blue Shield of California Commercial |
$504.77
|
| Rate for Payer: Blue Shield of California EPN |
$329.11
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.60
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.86 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Adventist Health Commercial |
$267.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.51
|
| Rate for Payer: Blue Shield of California Commercial |
$504.77
|
| Rate for Payer: Blue Shield of California EPN |
$329.11
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Cash Price |
$359.15
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Senior |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$228.18
|
| Rate for Payer: InnovAge PACE Commercial |
$326.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$404.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$457.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$457.10
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Riverside University Health System MISP |
$261.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$245.07
|
| Rate for Payer: United Healthcare All Other HMO |
$238.54
|
| Rate for Payer: United Healthcare HMO Rider |
$233.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
915355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$669.60 |
| Rate for Payer: Adventist Health Commercial |
$148.80
|
| Rate for Payer: Blue Shield of California Commercial |
$575.11
|
| Rate for Payer: Blue Shield of California EPN |
$374.98
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Central Health Plan Commercial |
$595.20
|
| Rate for Payer: Cigna of CA HMO |
$520.80
|
| Rate for Payer: Cigna of CA PPO |
$520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.80
|
| Rate for Payer: Multiplan Commercial |
$558.00
|
| Rate for Payer: Networks By Design Commercial |
$483.60
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.22
|
| Rate for Payer: United Healthcare All Other HMO |
$271.78
|
| Rate for Payer: United Healthcare HMO Rider |
$265.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.66
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
915355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.18 |
| Max. Negotiated Rate |
$669.60 |
| Rate for Payer: Adventist Health Commercial |
$305.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$436.95
|
| Rate for Payer: Blue Shield of California Commercial |
$575.11
|
| Rate for Payer: Blue Shield of California EPN |
$374.98
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Cash Price |
$409.20
|
| Rate for Payer: Central Health Plan Commercial |
$595.20
|
| Rate for Payer: Cigna of CA HMO |
$520.80
|
| Rate for Payer: Cigna of CA PPO |
$520.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$632.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$297.60
|
| Rate for Payer: EPIC Health Plan Senior |
$297.60
|
| Rate for Payer: Galaxy Health WC |
$632.40
|
| Rate for Payer: Global Benefits Group Commercial |
$446.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$669.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$228.18
|
| Rate for Payer: InnovAge PACE Commercial |
$372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$460.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$520.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$520.80
|
| Rate for Payer: Multiplan Commercial |
$558.00
|
| Rate for Payer: Networks By Design Commercial |
$372.00
|
| Rate for Payer: Prime Health Services Commercial |
$632.40
|
| Rate for Payer: Riverside University Health System MISP |
$297.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$446.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$446.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.22
|
| Rate for Payer: United Healthcare All Other HMO |
$271.78
|
| Rate for Payer: United Healthcare HMO Rider |
$265.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.40
|
| Rate for Payer: Vantage Medical Group Senior |
$632.40
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
OP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,363.82 |
| Max. Negotiated Rate |
$11,909.70 |
| Rate for Payer: Adventist Health Commercial |
$5,425.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,278.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,771.74
|
| Rate for Payer: Blue Shield of California Commercial |
$10,229.11
|
| Rate for Payer: Blue Shield of California EPN |
$6,669.43
|
| Rate for Payer: Cash Price |
$7,278.15
|
| Rate for Payer: Cash Price |
$7,278.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,586.40
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,248.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,248.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,909.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,363.82
|
| Rate for Payer: InnovAge PACE Commercial |
$6,616.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,191.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,425.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,263.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,263.10
|
| Rate for Payer: Multiplan Commercial |
$9,924.75
|
| Rate for Payer: Networks By Design Commercial |
$6,616.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: Riverside University Health System MISP |
$5,293.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,939.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,939.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11,248.05
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
IP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,646.60 |
| Max. Negotiated Rate |
$11,909.70 |
| Rate for Payer: Adventist Health Commercial |
$2,646.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,229.11
|
| Rate for Payer: Blue Shield of California EPN |
$6,669.43
|
| Rate for Payer: Cash Price |
$7,278.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,586.40
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,909.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,041.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,191.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,646.60
|
| Rate for Payer: Multiplan Commercial |
$9,924.75
|
| Rate for Payer: Networks By Design Commercial |
$8,601.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
IP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,646.60 |
| Max. Negotiated Rate |
$11,909.70 |
| Rate for Payer: Adventist Health Commercial |
$2,646.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,229.11
|
| Rate for Payer: Blue Shield of California EPN |
$6,669.43
|
| Rate for Payer: Cash Price |
$7,278.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,586.40
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,909.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,041.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,191.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,646.60
|
| Rate for Payer: Multiplan Commercial |
$9,924.75
|
| Rate for Payer: Networks By Design Commercial |
$8,601.45
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
|
|
HC BK MOLD SKT SACH ENDOSKELETAL
|
Facility
|
OP
|
$13,233.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,363.82 |
| Max. Negotiated Rate |
$11,909.70 |
| Rate for Payer: Adventist Health Commercial |
$5,425.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,278.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,924.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,771.74
|
| Rate for Payer: Blue Shield of California Commercial |
$10,229.11
|
| Rate for Payer: Blue Shield of California EPN |
$6,669.43
|
| Rate for Payer: Cash Price |
$7,278.15
|
| Rate for Payer: Cash Price |
$7,278.15
|
| Rate for Payer: Central Health Plan Commercial |
$10,586.40
|
| Rate for Payer: Cigna of CA HMO |
$9,263.10
|
| Rate for Payer: Cigna of CA PPO |
$9,263.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,248.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,248.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,293.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,293.20
|
| Rate for Payer: Galaxy Health WC |
$11,248.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,939.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,909.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,363.82
|
| Rate for Payer: InnovAge PACE Commercial |
$6,616.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,191.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,425.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,263.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,263.10
|
| Rate for Payer: Multiplan Commercial |
$9,924.75
|
| Rate for Payer: Networks By Design Commercial |
$6,616.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,248.05
|
| Rate for Payer: Riverside University Health System MISP |
$5,293.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,939.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,939.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,966.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,834.01
|
| Rate for Payer: United Healthcare HMO Rider |
$4,729.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,333.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,248.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11,248.05
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
OP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
915355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,758.48 |
| Max. Negotiated Rate |
$6,066.90 |
| Rate for Payer: Adventist Health Commercial |
$2,763.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,707.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,055.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,958.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5,210.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,397.46
|
| Rate for Payer: Cash Price |
$3,707.55
|
| Rate for Payer: Cash Price |
$3,707.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,392.80
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,729.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,729.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,066.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,758.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,370.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,172.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,763.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,718.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,718.70
|
| Rate for Payer: Multiplan Commercial |
$5,055.75
|
| Rate for Payer: Networks By Design Commercial |
$3,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,696.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,044.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,044.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,729.85
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
OP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
905355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,758.48 |
| Max. Negotiated Rate |
$6,066.90 |
| Rate for Payer: Adventist Health Commercial |
$2,763.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,707.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,055.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,958.99
|
| Rate for Payer: Blue Shield of California Commercial |
$5,210.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,397.46
|
| Rate for Payer: Cash Price |
$3,707.55
|
| Rate for Payer: Cash Price |
$3,707.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,392.80
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,729.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,729.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,066.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,758.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,370.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,172.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,763.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,718.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,718.70
|
| Rate for Payer: Multiplan Commercial |
$5,055.75
|
| Rate for Payer: Networks By Design Commercial |
$3,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,696.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,044.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,044.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,729.85
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
IP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
905355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.20 |
| Max. Negotiated Rate |
$6,066.90 |
| Rate for Payer: Adventist Health Commercial |
$1,348.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,210.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,397.46
|
| Rate for Payer: Cash Price |
$3,707.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,392.80
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,066.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,568.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,172.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.20
|
| Rate for Payer: Multiplan Commercial |
$5,055.75
|
| Rate for Payer: Networks By Design Commercial |
$4,381.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
IP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
915355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.20 |
| Max. Negotiated Rate |
$6,066.90 |
| Rate for Payer: Adventist Health Commercial |
$1,348.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,210.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,397.46
|
| Rate for Payer: Cash Price |
$3,707.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,392.80
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,066.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,568.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,172.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.20
|
| Rate for Payer: Multiplan Commercial |
$5,055.75
|
| Rate for Payer: Networks By Design Commercial |
$4,381.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,529.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,462.49
|
| Rate for Payer: United Healthcare HMO Rider |
$2,409.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,207.68
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
OP
|
$3,211.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
915355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,051.60 |
| Max. Negotiated Rate |
$2,889.90 |
| Rate for Payer: Adventist Health Commercial |
$1,316.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,729.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,766.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,408.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,885.82
|
| Rate for Payer: Blue Shield of California Commercial |
$2,482.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,618.34
|
| Rate for Payer: Cash Price |
$1,766.05
|
| Rate for Payer: Cash Price |
$1,766.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,568.80
|
| Rate for Payer: Cigna of CA HMO |
$2,247.70
|
| Rate for Payer: Cigna of CA PPO |
$2,247.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,729.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,729.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,284.40
|
| Rate for Payer: Galaxy Health WC |
$2,729.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,926.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,889.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,081.58
|
| Rate for Payer: InnovAge PACE Commercial |
$1,605.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,299.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,987.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,316.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,247.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,247.70
|
| Rate for Payer: Multiplan Commercial |
$2,408.25
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,729.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,926.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,926.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,205.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1,172.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,051.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,729.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,729.35
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
905355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$563.40 |
| Max. Negotiated Rate |
$2,535.30 |
| Rate for Payer: Adventist Health Commercial |
$563.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,177.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,419.77
|
| Rate for Payer: Cash Price |
$1,549.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,253.60
|
| Rate for Payer: Cigna of CA HMO |
$1,971.90
|
| Rate for Payer: Cigna of CA PPO |
$1,971.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,126.80
|
| Rate for Payer: Galaxy Health WC |
$2,394.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,690.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,535.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,878.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,743.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.40
|
| Rate for Payer: Multiplan Commercial |
$2,112.75
|
| Rate for Payer: Networks By Design Commercial |
$1,831.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,394.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,057.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,029.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1,006.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$922.57
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
IP
|
$3,211.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
915355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$642.20 |
| Max. Negotiated Rate |
$2,889.90 |
| Rate for Payer: Adventist Health Commercial |
$642.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,482.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,618.34
|
| Rate for Payer: Cash Price |
$1,766.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,568.80
|
| Rate for Payer: Cigna of CA HMO |
$2,247.70
|
| Rate for Payer: Cigna of CA PPO |
$2,247.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,284.40
|
| Rate for Payer: Galaxy Health WC |
$2,729.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,926.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,889.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,223.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,987.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.20
|
| Rate for Payer: Multiplan Commercial |
$2,408.25
|
| Rate for Payer: Networks By Design Commercial |
$2,087.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,729.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,205.09
|
| Rate for Payer: United Healthcare All Other HMO |
$1,172.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,051.60
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
905355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$922.57 |
| Max. Negotiated Rate |
$2,535.30 |
| Rate for Payer: Adventist Health Commercial |
$1,154.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,549.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,112.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,654.42
|
| Rate for Payer: Blue Shield of California Commercial |
$2,177.54
|
| Rate for Payer: Blue Shield of California EPN |
$1,419.77
|
| Rate for Payer: Cash Price |
$1,549.35
|
| Rate for Payer: Cash Price |
$1,549.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,253.60
|
| Rate for Payer: Cigna of CA HMO |
$1,971.90
|
| Rate for Payer: Cigna of CA PPO |
$1,971.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,394.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,394.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,126.80
|
| Rate for Payer: Galaxy Health WC |
$2,394.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,690.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,535.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,081.58
|
| Rate for Payer: InnovAge PACE Commercial |
$1,408.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,878.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,299.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,743.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,971.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,971.90
|
| Rate for Payer: Multiplan Commercial |
$2,112.75
|
| Rate for Payer: Networks By Design Commercial |
$1,408.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,394.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,126.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,690.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,690.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,057.22
|
| Rate for Payer: United Healthcare All Other HMO |
$1,029.05
|
| Rate for Payer: United Healthcare HMO Rider |
$1,006.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$922.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,394.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,394.45
|
|
|
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 |
$2,873.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.37
|
| Rate for Payer: Cash Price |
$2,044.35
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,416.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,300.82
|
| 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
|
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 |
$2,182.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,873.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.37
|
| Rate for Payer: Cash Price |
$2,044.35
|
| Rate for Payer: Cash Price |
$2,044.35
|
| 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: 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: InnovAge PACE Commercial |
$1,858.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,099.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA 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 |
$2,182.99
|
| Rate for Payer: Blue Shield of California Commercial |
$2,873.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.37
|
| Rate for Payer: Cash Price |
$2,044.35
|
| Rate for Payer: Cash Price |
$2,044.35
|
| 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: 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: InnovAge PACE Commercial |
$1,858.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,099.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,300.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,601.90
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
