|
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 LAMINATED SOCKET
|
Facility
|
IP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
915355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.60 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$828.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,202.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$2,278.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,763.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,578.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,564.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.60
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,692.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
OP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
915355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,356.83 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$1,698.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,278.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,433.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,202.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$2,278.65
|
| Rate for Payer: Cash Price |
$2,278.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,521.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,521.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,831.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,071.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,763.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,023.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,564.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,698.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,900.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,900.10
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,071.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,657.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,521.55
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
OP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
905355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,356.83 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$1,698.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,278.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,433.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,202.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$2,278.65
|
| Rate for Payer: Cash Price |
$2,278.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,521.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,521.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,831.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,071.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,763.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,023.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,564.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,698.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,900.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,900.10
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,071.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,657.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,521.55
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
IP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
905355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.60 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Adventist Health Commercial |
$828.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,202.54
|
| Rate for Payer: Blue Shield of California EPN |
$2,088.07
|
| Rate for Payer: Cash Price |
$2,278.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,763.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,578.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,564.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.60
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,692.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,554.87
|
| Rate for Payer: United Healthcare All Other HMO |
$1,513.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,356.83
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
905355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$397.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$1,093.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$1,292.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
915355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$651.07 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$815.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,167.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$1,093.40
|
| Rate for Payer: Cash Price |
$1,093.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,689.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.90
|
| Rate for Payer: InnovAge PACE Commercial |
$994.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,391.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Riverside University Health System MISP |
$795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
905355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$651.07 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$815.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,167.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$1,093.40
|
| Rate for Payer: Cash Price |
$1,093.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,689.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.90
|
| Rate for Payer: InnovAge PACE Commercial |
$994.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,391.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,391.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Riverside University Health System MISP |
$795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
915355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Adventist Health Commercial |
$397.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.72
|
| Rate for Payer: Blue Shield of California EPN |
$1,001.95
|
| Rate for Payer: Cash Price |
$1,093.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Senior |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,230.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$1,292.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.10
|
| Rate for Payer: United Healthcare All Other HMO |
$726.22
|
| Rate for Payer: United Healthcare HMO Rider |
$710.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$651.07
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,337.40 |
| Rate for Payer: Adventist Health Commercial |
$297.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,148.68
|
| Rate for Payer: Blue Shield of California EPN |
$748.94
|
| Rate for Payer: Cash Price |
$817.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$965.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$557.70
|
| Rate for Payer: United Healthcare All Other HMO |
$542.84
|
| Rate for Payer: United Healthcare HMO Rider |
$531.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.67
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
IP
|
$3,772.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
915355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$754.40 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Adventist Health Commercial |
$754.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,915.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,901.09
|
| Rate for Payer: Cash Price |
$2,074.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: Cigna of CA HMO |
$2,640.40
|
| Rate for Payer: Cigna of CA PPO |
$2,640.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,437.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,334.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$754.40
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$2,451.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.33
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.67 |
| Max. Negotiated Rate |
$1,492.94 |
| Rate for Payer: Adventist Health Commercial |
$609.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,114.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$872.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,148.68
|
| Rate for Payer: Blue Shield of California EPN |
$748.94
|
| Rate for Payer: Cash Price |
$817.30
|
| Rate for Payer: Cash Price |
$817.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,351.51
|
| Rate for Payer: InnovAge PACE Commercial |
$743.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$919.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,040.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,040.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$743.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: Riverside University Health System MISP |
$594.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$557.70
|
| Rate for Payer: United Healthcare All Other HMO |
$542.84
|
| Rate for Payer: United Healthcare HMO Rider |
$531.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.10
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
OP
|
$3,772.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
915355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,235.33 |
| Max. Negotiated Rate |
$3,394.80 |
| Rate for Payer: Adventist Health Commercial |
$1,546.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,074.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,829.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,215.30
|
| Rate for Payer: Blue Shield of California Commercial |
$2,915.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,901.09
|
| Rate for Payer: Cash Price |
$2,074.60
|
| Rate for Payer: Cash Price |
$2,074.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,017.60
|
| Rate for Payer: Cigna of CA HMO |
$2,640.40
|
| Rate for Payer: Cigna of CA PPO |
$2,640.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,206.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,206.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,508.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,508.80
|
| Rate for Payer: Galaxy Health WC |
$3,206.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,263.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,394.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,351.51
|
| Rate for Payer: InnovAge PACE Commercial |
$1,886.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,515.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,334.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,546.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,640.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,640.40
|
| Rate for Payer: Multiplan Commercial |
$2,829.00
|
| Rate for Payer: Networks By Design Commercial |
$1,886.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,206.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,508.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,263.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,263.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,415.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,377.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,348.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,235.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,206.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,206.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,206.20
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,715.12 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$2,147.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,927.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,075.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,048.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,880.35
|
| Rate for Payer: Cash Price |
$2,880.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,451.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,363.82
|
| Rate for Payer: InnovAge PACE Commercial |
$2,618.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,665.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,665.90
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,094.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.45
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$1,047.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,048.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,880.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,047.40
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$3,404.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$1,047.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,048.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,880.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,047.40
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$3,404.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
915355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,715.12 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Adventist Health Commercial |
$2,147.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,927.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,075.69
|
| Rate for Payer: Blue Shield of California Commercial |
$4,048.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,639.45
|
| Rate for Payer: Cash Price |
$2,880.35
|
| Rate for Payer: Cash Price |
$2,880.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,451.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,363.82
|
| Rate for Payer: InnovAge PACE Commercial |
$2,618.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,715.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,241.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,665.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,665.90
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,094.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,965.45
|
| Rate for Payer: United Healthcare All Other HMO |
$1,913.08
|
| Rate for Payer: United Healthcare HMO Rider |
$1,871.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,715.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.45
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
915355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.22 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$429.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.49
|
| Rate for Payer: Blue Shield of California Commercial |
$810.10
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.81
|
| Rate for Payer: InnovAge PACE Commercial |
$524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$733.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Riverside University Health System MISP |
$419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Blue Shield of California Commercial |
$810.10
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
915355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Blue Shield of California Commercial |
$810.10
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.22 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$429.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.49
|
| Rate for Payer: Blue Shield of California Commercial |
$810.10
|
| Rate for Payer: Blue Shield of California EPN |
$528.19
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Cash Price |
$576.40
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$466.81
|
| Rate for Payer: InnovAge PACE Commercial |
$524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$733.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Riverside University Health System MISP |
$419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.31
|
| Rate for Payer: United Healthcare All Other HMO |
$382.83
|
| Rate for Payer: United Healthcare HMO Rider |
$374.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
915355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,054.41 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$2,571.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,450.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,704.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,684.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,849.03
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,332.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,332.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,795.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,136.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,087.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,571.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,391.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,391.10
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,509.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,332.05
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
905355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$1,254.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,849.03
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,390.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.60
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$4,077.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
915355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$1,254.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,849.03
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,390.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.60
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$4,077.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
905355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,054.41 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Adventist Health Commercial |
$2,571.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,450.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,704.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,684.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,849.03
|
| Rate for Payer: Blue Shield of California EPN |
$3,161.59
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Cash Price |
$3,450.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,332.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,332.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,795.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,136.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,087.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,882.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,571.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,391.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,391.10
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,509.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,354.26
|
| Rate for Payer: United Healthcare All Other HMO |
$2,291.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,241.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,054.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,332.05
|
|
