|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
IP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
905355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$179.00 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Blue Shield of California EPN |
$477.93
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.00
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.95
|
| Rate for Payer: United Healthcare All Other HMO |
$330.08
|
| Rate for Payer: United Healthcare HMO Rider |
$322.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.35
|
|
|
HC AK/HD ADD HIP AMNUAL LOCK
|
Facility
|
OP
|
$895.00
|
|
|
Service Code
|
CPT L5925
|
| Hospital Charge Code |
905355925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$313.25 |
| Max. Negotiated Rate |
$805.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$492.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$433.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.77
|
| Rate for Payer: Blue Distinction Transplant |
$537.00
|
| Rate for Payer: Blue Shield of California Commercial |
$671.25
|
| Rate for Payer: Blue Shield of California EPN |
$486.88
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Cash Price |
$402.75
|
| Rate for Payer: Central Health Plan Commercial |
$716.00
|
| Rate for Payer: Cigna of CA HMO |
$626.50
|
| Rate for Payer: Cigna of CA PPO |
$626.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.75
|
| Rate for Payer: Dignity Health Media |
$760.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$760.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$358.00
|
| Rate for Payer: Galaxy Health WC |
$760.75
|
| Rate for Payer: Global Benefits Group Commercial |
$537.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$805.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$671.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$313.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.95
|
| Rate for Payer: Multiplan Commercial |
$671.25
|
| Rate for Payer: Networks By Design Commercial |
$447.50
|
| Rate for Payer: Prime Health Services Commercial |
$760.75
|
| Rate for Payer: Riverside University Health System MISP |
$358.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$537.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$537.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.50
|
| Rate for Payer: United Healthcare All Other HMO |
$447.50
|
| Rate for Payer: United Healthcare HMO Rider |
$447.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$447.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$760.75
|
| Rate for Payer: Vantage Medical Group Senior |
$760.75
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
OP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
905355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,100.05 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,728.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,728.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,521.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,856.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,885.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,357.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,709.79
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,514.40
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,671.55
|
| Rate for Payer: Dignity Health Media |
$2,671.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,671.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,828.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,357.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,100.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,096.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,333.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.63
|
| Rate for Payer: Multiplan Commercial |
$2,357.25
|
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,257.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,885.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,885.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,571.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,571.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,571.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,571.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,671.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,671.55
|
|
|
HC AK INITL PLSTR SKT SACH FOOT
|
Facility
|
IP
|
$3,143.00
|
|
|
Service Code
|
CPT L5505
|
| Hospital Charge Code |
905355505
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.60 |
| Max. Negotiated Rate |
$2,828.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,678.36
|
| Rate for Payer: Cash Price |
$1,414.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,514.40
|
| Rate for Payer: Cigna of CA HMO |
$2,200.10
|
| Rate for Payer: Cigna of CA PPO |
$2,200.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,257.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,257.20
|
| Rate for Payer: Galaxy Health WC |
$2,671.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,828.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,096.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,197.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.60
|
| Rate for Payer: Multiplan Commercial |
$2,357.25
|
| Rate for Payer: Networks By Design Commercial |
$1,571.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,671.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,186.80
|
| Rate for Payer: United Healthcare All Other HMO |
$1,159.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,133.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,037.19
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
905355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Blue Shield of California EPN |
$278.75
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$365.40
|
| Rate for Payer: Cigna of CA PPO |
$365.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$261.00
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.11
|
| Rate for Payer: United Healthcare All Other HMO |
$192.51
|
| Rate for Payer: United Healthcare HMO Rider |
$188.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.26
|
|
|
HC AK IPOP ADD CAST/ALIGN CHANGES
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT L5430
|
| Hospital Charge Code |
905355430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$443.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$287.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.40
|
| Rate for Payer: Blue Distinction Transplant |
$313.20
|
| Rate for Payer: Blue Shield of California Commercial |
$391.50
|
| Rate for Payer: Blue Shield of California EPN |
$283.97
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: Cigna of CA HMO |
$365.40
|
| Rate for Payer: Cigna of CA PPO |
$365.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.70
|
| Rate for Payer: Dignity Health Media |
$443.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$443.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$391.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$396.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.02
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$261.00
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
| Rate for Payer: Riverside University Health System MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.70
|
| Rate for Payer: Vantage Medical Group Senior |
$443.70
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
905355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$849.10 |
| Max. Negotiated Rate |
$2,183.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,334.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,334.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,174.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,433.28
|
| Rate for Payer: Blue Distinction Transplant |
$1,455.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,819.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,319.74
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.80
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,062.10
|
| Rate for Payer: Dignity Health Media |
$2,062.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,062.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,183.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,819.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$849.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,430.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.66
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: Riverside University Health System MISP |
$970.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,213.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,213.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,213.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,062.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,062.10
|
|
|
HC AK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$2,426.00
|
|
|
Service Code
|
CPT L5420
|
| Hospital Charge Code |
905355420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$2,183.40 |
| Rate for Payer: Blue Shield of California EPN |
$1,295.48
|
| Rate for Payer: Cash Price |
$1,091.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.80
|
| Rate for Payer: Cigna of CA HMO |
$1,698.20
|
| Rate for Payer: Cigna of CA PPO |
$1,698.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$970.40
|
| Rate for Payer: Galaxy Health WC |
$2,062.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,183.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,618.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$924.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.20
|
| Rate for Payer: Multiplan Commercial |
$1,819.50
|
| Rate for Payer: Networks By Design Commercial |
$1,213.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,062.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$916.06
|
| Rate for Payer: United Healthcare All Other HMO |
$894.71
|
| Rate for Payer: United Healthcare HMO Rider |
$875.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$800.58
|
|
|
HC AK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5460
|
| Hospital Charge Code |
905355460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$423.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.95
|
| Rate for Payer: Blue Distinction Transplant |
$525.00
|
| Rate for Payer: Blue Shield of California Commercial |
$656.25
|
| Rate for Payer: Blue Shield of California EPN |
$476.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Media |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$656.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.75
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Riverside University Health System MISP |
$350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC AK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT L5460
|
| Hospital Charge Code |
905355460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Blue Shield of California EPN |
$467.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.40
|
| Rate for Payer: United Healthcare All Other HMO |
$322.70
|
| Rate for Payer: United Healthcare HMO Rider |
$315.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$288.75
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
IP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,376.80 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Blue Shield of California EPN |
$6,346.06
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,926.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,527.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,376.80
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,487.40
|
| Rate for Payer: United Healthcare All Other HMO |
$4,382.82
|
| Rate for Payer: United Healthcare HMO Rider |
$4,287.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,921.72
|
|
|
HC AK PFFD SACH FOOT
|
Facility
|
OP
|
$11,884.00
|
|
|
Service Code
|
CPT L5230
|
| Hospital Charge Code |
905355230
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,159.40 |
| Max. Negotiated Rate |
$10,695.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,536.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,536.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,754.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,021.07
|
| Rate for Payer: Blue Distinction Transplant |
$7,130.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,913.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,464.90
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Cash Price |
$5,347.80
|
| Rate for Payer: Central Health Plan Commercial |
$9,507.20
|
| Rate for Payer: Cigna of CA HMO |
$8,318.80
|
| Rate for Payer: Cigna of CA PPO |
$8,318.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,101.40
|
| Rate for Payer: Dignity Health Media |
$10,101.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,101.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,753.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,753.60
|
| Rate for Payer: Galaxy Health WC |
$10,101.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,130.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,695.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,913.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,159.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,926.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,581.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,872.44
|
| Rate for Payer: Multiplan Commercial |
$8,913.00
|
| Rate for Payer: Networks By Design Commercial |
$5,942.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,101.40
|
| Rate for Payer: Riverside University Health System MISP |
$4,753.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,130.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,942.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,942.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,942.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,101.40
|
| Rate for Payer: Vantage Medical Group Senior |
$10,101.40
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
IP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$799.80 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Blue Shield of California EPN |
$2,135.47
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,667.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,523.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$799.80
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,510.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1,474.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,442.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.67
|
|
|
HC AK PREARATORY PREFAB SOCKET
|
Facility
|
OP
|
$3,999.00
|
|
|
Service Code
|
CPT L5585
|
| Hospital Charge Code |
905355585
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,399.65 |
| Max. Negotiated Rate |
$3,599.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,199.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,199.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,936.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,362.61
|
| Rate for Payer: Blue Distinction Transplant |
$2,399.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,999.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,175.46
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Cash Price |
$1,799.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,199.20
|
| Rate for Payer: Cigna of CA HMO |
$2,799.30
|
| Rate for Payer: Cigna of CA PPO |
$2,799.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,399.15
|
| Rate for Payer: Dignity Health Media |
$3,399.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,399.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,599.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,599.60
|
| Rate for Payer: Galaxy Health WC |
$3,399.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,399.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,599.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,999.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,399.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,667.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,386.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,639.59
|
| Rate for Payer: Multiplan Commercial |
$2,999.25
|
| Rate for Payer: Networks By Design Commercial |
$1,999.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,399.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,599.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,399.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,399.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,999.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,999.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,999.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,999.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,399.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,399.15
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
OP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,799.35 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,827.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,827.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,489.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,037.30
|
| Rate for Payer: Blue Distinction Transplant |
$3,084.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,855.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,796.70
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,369.85
|
| Rate for Payer: Dignity Health Media |
$4,369.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,369.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,855.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,799.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,383.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,107.81
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,056.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,084.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,084.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,570.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,570.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,570.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,570.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,369.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,369.85
|
|
|
HC AK PREP CUSTOM THERMOPLASTIC
|
Facility
|
IP
|
$5,141.00
|
|
|
Service Code
|
CPT L5580
|
| Hospital Charge Code |
905355580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,028.20 |
| Max. Negotiated Rate |
$4,626.90 |
| Rate for Payer: Blue Shield of California EPN |
$2,745.29
|
| Rate for Payer: Cash Price |
$2,313.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,112.80
|
| Rate for Payer: Cigna of CA HMO |
$3,598.70
|
| Rate for Payer: Cigna of CA PPO |
$3,598.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,056.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,056.40
|
| Rate for Payer: Galaxy Health WC |
$4,369.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,626.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,429.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,958.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,028.20
|
| Rate for Payer: Multiplan Commercial |
$3,855.75
|
| Rate for Payer: Networks By Design Commercial |
$2,570.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,369.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,941.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,854.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,696.53
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
IP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,101.40 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Blue Shield of California EPN |
$2,940.74
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,673.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,098.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.40
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$2,753.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,079.44
|
| Rate for Payer: United Healthcare All Other HMO |
$2,030.98
|
| Rate for Payer: United Healthcare HMO Rider |
$1,986.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,817.31
|
|
|
HC AK PREP LAMINATED SOCKET SACH
|
Facility
|
OP
|
$5,507.00
|
|
|
Service Code
|
CPT L5590
|
| Hospital Charge Code |
905355590
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,927.45 |
| Max. Negotiated Rate |
$4,956.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,028.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,028.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,666.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,253.54
|
| Rate for Payer: Blue Distinction Transplant |
$3,304.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,130.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,995.81
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Cash Price |
$2,478.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,405.60
|
| Rate for Payer: Cigna of CA HMO |
$3,854.90
|
| Rate for Payer: Cigna of CA PPO |
$3,854.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,680.95
|
| Rate for Payer: Dignity Health Media |
$4,680.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,680.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,202.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,202.80
|
| Rate for Payer: Galaxy Health WC |
$4,680.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,304.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,956.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,130.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,927.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,673.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,836.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,257.87
|
| Rate for Payer: Multiplan Commercial |
$4,130.25
|
| Rate for Payer: Networks By Design Commercial |
$2,753.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,680.95
|
| Rate for Payer: Riverside University Health System MISP |
$2,202.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,753.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,753.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,753.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,753.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,680.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,680.95
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
IP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.00 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,420.44
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,013.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$532.00
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,004.42
|
| Rate for Payer: United Healthcare All Other HMO |
$981.01
|
| Rate for Payer: United Healthcare HMO Rider |
$959.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.80
|
|
|
HC AK PREP PLSTR SOCKET SACH FOOT
|
Facility
|
OP
|
$2,660.00
|
|
|
Service Code
|
CPT L5560
|
| Hospital Charge Code |
905355560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.00 |
| Max. Negotiated Rate |
$2,394.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,463.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,463.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,287.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,571.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,596.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,995.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,447.04
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Cash Price |
$1,197.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,128.00
|
| Rate for Payer: Cigna of CA HMO |
$1,862.00
|
| Rate for Payer: Cigna of CA PPO |
$1,862.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,261.00
|
| Rate for Payer: Dignity Health Media |
$2,261.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,064.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,064.00
|
| Rate for Payer: Galaxy Health WC |
$2,261.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,596.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,394.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,995.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$931.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,774.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,090.60
|
| Rate for Payer: Multiplan Commercial |
$1,995.00
|
| Rate for Payer: Networks By Design Commercial |
$1,330.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,261.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,064.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,596.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,596.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,330.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,330.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,330.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,330.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,261.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,261.00
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
IP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,183.20 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Blue Shield of California EPN |
$3,159.14
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,254.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,183.20
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,233.88
|
| Rate for Payer: United Healthcare All Other HMO |
$2,181.82
|
| Rate for Payer: United Healthcare HMO Rider |
$2,134.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,952.28
|
|
|
HC AK PREP THERMOPLASTIC SOCKET
|
Facility
|
OP
|
$5,916.00
|
|
|
Service Code
|
CPT L5570
|
| Hospital Charge Code |
905355570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,070.60 |
| Max. Negotiated Rate |
$5,324.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,253.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,253.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,864.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,495.17
|
| Rate for Payer: Blue Distinction Transplant |
$3,549.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,437.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,218.30
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Cash Price |
$2,662.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,732.80
|
| Rate for Payer: Cigna of CA HMO |
$4,141.20
|
| Rate for Payer: Cigna of CA PPO |
$4,141.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,028.60
|
| Rate for Payer: Dignity Health Media |
$5,028.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,028.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,366.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,366.40
|
| Rate for Payer: Galaxy Health WC |
$5,028.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,549.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,324.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,437.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,070.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,945.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,218.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,425.56
|
| Rate for Payer: Multiplan Commercial |
$4,437.00
|
| Rate for Payer: Networks By Design Commercial |
$2,958.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,028.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,366.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,549.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,958.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,958.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,958.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,958.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,028.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,028.60
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,635.15 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,140.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,140.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,645.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,448.13
|
| Rate for Payer: Blue Distinction Transplant |
$4,517.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,646.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,095.78
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,399.65
|
| Rate for Payer: Dignity Health Media |
$6,399.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,399.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,646.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,635.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,341.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,086.89
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,011.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,517.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,517.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,764.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,764.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,764.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,764.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,399.65
|
| Rate for Payer: Vantage Medical Group Senior |
$6,399.65
|
|
|
HC AK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$7,529.00
|
|
|
Service Code
|
CPT L5321
|
| Hospital Charge Code |
905355321
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,505.80 |
| Max. Negotiated Rate |
$6,776.10 |
| Rate for Payer: Blue Shield of California EPN |
$4,020.49
|
| Rate for Payer: Cash Price |
$3,388.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,023.20
|
| Rate for Payer: Cigna of CA HMO |
$5,270.30
|
| Rate for Payer: Cigna of CA PPO |
$5,270.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,011.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,011.60
|
| Rate for Payer: Galaxy Health WC |
$6,399.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,517.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,776.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,021.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,505.80
|
| Rate for Payer: Multiplan Commercial |
$5,646.75
|
| Rate for Payer: Networks By Design Commercial |
$3,764.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,399.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,842.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2,776.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,716.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,484.57
|
|
|
HC AK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,720.00
|
|
|
Service Code
|
CPT L5705
|
| Hospital Charge Code |
905355705
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$1,548.00 |
| Rate for Payer: Blue Shield of California EPN |
$918.48
|
| Rate for Payer: Cash Price |
$774.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.00
|
| Rate for Payer: Cigna of CA HMO |
$1,204.00
|
| Rate for Payer: Cigna of CA PPO |
$1,204.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$688.00
|
| Rate for Payer: Galaxy Health WC |
$1,462.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.00
|
| Rate for Payer: Multiplan Commercial |
$1,290.00
|
| Rate for Payer: Networks By Design Commercial |
$860.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$649.47
|
| Rate for Payer: United Healthcare All Other HMO |
$634.34
|
| Rate for Payer: United Healthcare HMO Rider |
$620.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.60
|
|
