|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
OP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
905355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$471.10 |
| Max. Negotiated Rate |
$2,599.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,599.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$740.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$740.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.22
|
| Rate for Payer: BCBS Transplant Transplant |
$807.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,009.50
|
| Rate for Payer: Blue Shield of California EPN |
$732.22
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,009.50
|
| Rate for Payer: IEHP medi-cal |
$471.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.86
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Riverside University Health MISP |
$538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$673.00
|
| Rate for Payer: United Healthcare HMO Rider |
$673.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$673.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.10
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
905355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Blue Shield of California EPN |
$718.76
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
905355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Blue Shield of California EPN |
$277.68
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
905355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,405.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,405.63
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.22
|
| Rate for Payer: BCBS Transplant Transplant |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$390.00
|
| Rate for Payer: Blue Shield of California EPN |
$282.88
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$390.00
|
| Rate for Payer: IEHP medi-cal |
$182.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$260.00
|
| Rate for Payer: United Healthcare HMO Rider |
$260.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION AIR CUSSION SOCKET
|
Facility
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
905355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.05 |
| Max. Negotiated Rate |
$2,423.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,423.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$694.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$611.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.18
|
| Rate for Payer: BCBS Transplant Transplant |
$757.80
|
| Rate for Payer: Blue Shield of California Commercial |
$947.25
|
| Rate for Payer: Blue Shield of California EPN |
$687.07
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$947.25
|
| Rate for Payer: IEHP medi-cal |
$442.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$631.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC BK ADDITION AIR CUSSION SOCKET
|
Facility
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
905355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Blue Shield of California EPN |
$674.44
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
OP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
905355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$225.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$225.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$70.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.62
|
| Rate for Payer: BCBS Transplant Transplant |
$76.80
|
| Rate for Payer: Blue Shield of California Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California EPN |
$69.63
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$96.00
|
| Rate for Payer: IEHP medi-cal |
$44.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.48
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Riverside University Health MISP |
$51.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64.00
|
| Rate for Payer: United Healthcare HMO Rider |
$64.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC BK ADDITION BACK CHECK
|
Facility
IP
|
$128.00
|
|
|
Service Code
|
CPT L5686
|
| Hospital Charge Code |
905355686
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Blue Shield of California EPN |
$68.35
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
905355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Blue Shield of California EPN |
$98.26
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC BK ADDITION CUFF SUSPENSION
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT L5666
|
| Hospital Charge Code |
905355666
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$309.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$309.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$156.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$101.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$101.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.71
|
| Rate for Payer: BCBS Transplant Transplant |
$110.40
|
| Rate for Payer: Blue Shield of California Commercial |
$138.00
|
| Rate for Payer: Blue Shield of California EPN |
$100.10
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Central Health Plan Commercial |
$147.20
|
| Rate for Payer: Cigna of CA HMO |
$128.80
|
| Rate for Payer: Cigna of CA PPO |
$128.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$138.00
|
| Rate for Payer: IEHP medi-cal |
$64.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$138.00
|
| Rate for Payer: Networks By Design Commercial |
$92.00
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
| Rate for Payer: Riverside University Health MISP |
$73.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.00
|
| Rate for Payer: United Healthcare All Other HMO |
$92.00
|
| Rate for Payer: United Healthcare HMO Rider |
$92.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.40
|
| Rate for Payer: Vantage Medical Group Senior |
$156.40
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
905355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$212.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$212.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$96.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$62.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.76
|
| Rate for Payer: BCBS Transplant Transplant |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$84.75
|
| Rate for Payer: Blue Shield of California EPN |
$61.47
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$84.75
|
| Rate for Payer: IEHP medi-cal |
$39.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.33
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
| Rate for Payer: Riverside University Health MISP |
$45.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.50
|
| Rate for Payer: United Healthcare All Other HMO |
$56.50
|
| Rate for Payer: United Healthcare HMO Rider |
$56.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.05
|
| Rate for Payer: Vantage Medical Group Senior |
$96.05
|
|
|
HC BK ADDITION FORK STRAP
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT L5684
|
| Hospital Charge Code |
905355684
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.60 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Central Health Plan Commercial |
$90.40
|
| Rate for Payer: Cigna of CA HMO |
$79.10
|
| Rate for Payer: Cigna of CA PPO |
$79.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$45.20
|
| Rate for Payer: Galaxy Health WC |
$96.05
|
| Rate for Payer: Global Benefits Group Commercial |
$67.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.60
|
| Rate for Payer: Multiplan Commercial |
$84.75
|
| Rate for Payer: Networks By Design Commercial |
$56.50
|
| Rate for Payer: Prime Health Services Commercial |
$96.05
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
905355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Blue Shield of California EPN |
$45.39
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC BK ADDITION JOINT COVERS PAIR
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT L5678
|
| Hospital Charge Code |
905355678
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$175.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$175.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$72.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$46.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.22
|
| Rate for Payer: BCBS Transplant Transplant |
$51.00
|
| Rate for Payer: Blue Shield of California Commercial |
$63.75
|
| Rate for Payer: Blue Shield of California EPN |
$46.24
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$59.50
|
| Rate for Payer: Cigna of CA PPO |
$59.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.00
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.75
|
| Rate for Payer: IEHP medi-cal |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.85
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Riverside University Health MISP |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other HMO |
$42.50
|
| Rate for Payer: United Healthcare HMO Rider |
$42.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.25
|
| Rate for Payer: Vantage Medical Group Senior |
$72.25
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
OP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
905355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$331.45 |
| Max. Negotiated Rate |
$2,152.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,152.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$804.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$520.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$520.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$458.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$559.49
|
| Rate for Payer: BCBS Transplant Transplant |
$568.20
|
| Rate for Payer: Blue Shield of California Commercial |
$710.25
|
| Rate for Payer: Blue Shield of California EPN |
$515.17
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$804.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$710.25
|
| Rate for Payer: IEHP medi-cal |
$331.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.27
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
| Rate for Payer: Riverside University Health MISP |
$378.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$568.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$568.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$473.50
|
| Rate for Payer: United Healthcare All Other HMO |
$473.50
|
| Rate for Payer: United Healthcare HMO Rider |
$473.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$473.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$804.95
|
| Rate for Payer: Vantage Medical Group Senior |
$804.95
|
|
|
HC BK ADDITION LEATHER SOCKET
|
Facility
IP
|
$947.00
|
|
|
Service Code
|
CPT L5638
|
| Hospital Charge Code |
905355638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$189.40 |
| Max. Negotiated Rate |
$852.30 |
| Rate for Payer: Blue Shield of California EPN |
$505.70
|
| Rate for Payer: Cash Price |
$426.15
|
| Rate for Payer: Central Health Plan Commercial |
$757.60
|
| Rate for Payer: Cigna of CA HMO |
$662.90
|
| Rate for Payer: Cigna of CA PPO |
$662.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$378.80
|
| Rate for Payer: Galaxy Health WC |
$804.95
|
| Rate for Payer: Global Benefits Group Commercial |
$568.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$852.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$631.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.40
|
| Rate for Payer: Multiplan Commercial |
$710.25
|
| Rate for Payer: Networks By Design Commercial |
$473.50
|
| Rate for Payer: Prime Health Services Commercial |
$804.95
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
OP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
905355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$637.70 |
| Max. Negotiated Rate |
$3,518.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,518.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,002.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,002.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$882.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,076.44
|
| Rate for Payer: BCBS Transplant Transplant |
$1,093.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,366.50
|
| Rate for Payer: Blue Shield of California EPN |
$991.17
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,457.60
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,548.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,639.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,366.50
|
| Rate for Payer: IEHP medi-cal |
$637.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.02
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: Riverside University Health MISP |
$728.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,093.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$911.00
|
| Rate for Payer: United Healthcare All Other HMO |
$911.00
|
| Rate for Payer: United Healthcare HMO Rider |
$911.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$911.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,548.70
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
IP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
905355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$364.40 |
| Max. Negotiated Rate |
$1,639.80 |
| Rate for Payer: Blue Shield of California EPN |
$972.95
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,457.60
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,639.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.40
|
| Rate for Payer: Multiplan Commercial |
$1,366.50
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
|
|
HC BK ADDITION TEST SOCKET
|
Facility
IP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
905355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Blue Shield of California EPN |
$277.68
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
|
|
HC BK ADDITION TEST SOCKET
|
Facility
OP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
905355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,229.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,229.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$251.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.22
|
| Rate for Payer: BCBS Transplant Transplant |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$390.00
|
| Rate for Payer: Blue Shield of California EPN |
$282.88
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$390.00
|
| Rate for Payer: IEHP medi-cal |
$182.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.20
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$260.00
|
| Rate for Payer: United Healthcare HMO Rider |
$260.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
OP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
905355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.65 |
| Max. Negotiated Rate |
$1,277.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,277.76
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$362.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$319.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$389.34
|
| Rate for Payer: BCBS Transplant Transplant |
$395.40
|
| Rate for Payer: Blue Shield of California Commercial |
$494.25
|
| Rate for Payer: Blue Shield of California EPN |
$358.50
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$494.25
|
| Rate for Payer: IEHP medi-cal |
$230.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.19
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Riverside University Health MISP |
$263.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$329.50
|
| Rate for Payer: United Healthcare All Other HMO |
$329.50
|
| Rate for Payer: United Healthcare HMO Rider |
$329.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$329.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
IP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
905355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Blue Shield of California EPN |
$351.91
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Central Health Plan Commercial |
$527.20
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$593.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.80
|
| Rate for Payer: Multiplan Commercial |
$494.25
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
905355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Blue Shield of California EPN |
$113.21
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
905355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$270.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$270.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.25
|
| Rate for Payer: BCBS Transplant Transplant |
$127.20
|
| Rate for Payer: Blue Shield of California Commercial |
$159.00
|
| Rate for Payer: Blue Shield of California EPN |
$115.33
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.00
|
| Rate for Payer: IEHP medi-cal |
$74.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.00
|
| Rate for Payer: United Healthcare All Other HMO |
$106.00
|
| Rate for Payer: United Healthcare HMO Rider |
$106.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
IP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
905355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$1,887.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,119.80
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,677.60
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,887.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.40
|
| Rate for Payer: Multiplan Commercial |
$1,572.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
|
