|
HC BK ADDITION WOOD SOCKET
|
Facility
OP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
905355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$733.95 |
| Max. Negotiated Rate |
$4,959.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,153.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,153.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,015.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,238.91
|
| Rate for Payer: BCBS Transplant Transplant |
$1,258.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,572.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,140.77
|
| Rate for Payer: Cash Price |
$943.65
|
| 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: Dignity Health Commercial/Exchange |
$1,782.45
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$1,572.75
|
| Rate for Payer: IEHP medi-cal |
$733.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.77
|
| 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
|
| Rate for Payer: Riverside University Health MISP |
$838.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,258.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,048.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,048.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,048.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,048.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,782.45
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
IP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
905355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Blue Shield of California EPN |
$407.98
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
OP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
905355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$2,180.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,180.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$420.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$420.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.37
|
| Rate for Payer: BCBS Transplant Transplant |
$458.40
|
| Rate for Payer: Blue Shield of California Commercial |
$573.00
|
| Rate for Payer: Blue Shield of California EPN |
$415.62
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$649.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$573.00
|
| Rate for Payer: IEHP medi-cal |
$267.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.24
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Riverside University Health MISP |
$305.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.00
|
| Rate for Payer: United Healthcare All Other HMO |
$382.00
|
| Rate for Payer: United Healthcare HMO Rider |
$382.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$382.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$649.40
|
| Rate for Payer: Vantage Medical Group Senior |
$649.40
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
IP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
905355676
|
|
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: 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
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
OP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
905355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$1,602.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,602.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$656.25
|
| Rate for Payer: IEHP medi-cal |
$306.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| 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 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 BK ADD MOLDED DISTAL CUSHION
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
905355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Blue Shield of California EPN |
$122.82
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC BK ADD MOLDED DISTAL CUSHION
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT L5668
|
| Hospital Charge Code |
905355668
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$446.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$446.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$126.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.88
|
| Rate for Payer: BCBS Transplant Transplant |
$138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.50
|
| Rate for Payer: Blue Shield of California EPN |
$125.12
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$172.50
|
| Rate for Payer: IEHP medi-cal |
$80.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.00
|
| Rate for Payer: United Healthcare All Other HMO |
$115.00
|
| Rate for Payer: United Healthcare HMO Rider |
$115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
IP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
905355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Blue Shield of California EPN |
$372.73
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
|
|
HC BK ADD REMOVABLE MEDIAL BRIM
|
Facility
OP
|
$698.00
|
|
|
Service Code
|
CPT L5672
|
| Hospital Charge Code |
905355672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$1,318.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,318.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$383.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$337.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.38
|
| Rate for Payer: BCBS Transplant Transplant |
$418.80
|
| Rate for Payer: Blue Shield of California Commercial |
$523.50
|
| Rate for Payer: Blue Shield of California EPN |
$379.71
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$523.50
|
| Rate for Payer: IEHP medi-cal |
$244.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.00
|
| Rate for Payer: United Healthcare All Other HMO |
$349.00
|
| Rate for Payer: United Healthcare HMO Rider |
$349.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
IP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
905355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Blue Shield of California EPN |
$626.38
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC BK ADD SKT INSRT MULTIDUROMET
|
Facility
OP
|
$1,173.00
|
|
|
Service Code
|
CPT L5665
|
| Hospital Charge Code |
905355665
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$410.55 |
| Max. Negotiated Rate |
$2,264.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,264.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$645.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$567.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$693.01
|
| Rate for Payer: BCBS Transplant Transplant |
$703.80
|
| Rate for Payer: Blue Shield of California Commercial |
$879.75
|
| Rate for Payer: Blue Shield of California EPN |
$638.11
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$821.10
|
| Rate for Payer: Cigna of CA PPO |
$821.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$879.75
|
| Rate for Payer: IEHP medi-cal |
$410.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.93
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$586.50
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Riverside University Health MISP |
$469.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$586.50
|
| Rate for Payer: United Healthcare All Other HMO |
$586.50
|
| Rate for Payer: United Healthcare HMO Rider |
$586.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$586.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
IP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
905355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$549.90 |
| Rate for Payer: Blue Shield of California EPN |
$326.27
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Central Health Plan Commercial |
$488.80
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.20
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
|
|
HC BK ADD SKT INSRT-PELITE LINER
|
Facility
OP
|
$611.00
|
|
|
Service Code
|
CPT L5655
|
| Hospital Charge Code |
905355655
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.85 |
| Max. Negotiated Rate |
$1,173.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,173.21
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$519.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$336.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$295.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.98
|
| Rate for Payer: BCBS Transplant Transplant |
$366.60
|
| Rate for Payer: Blue Shield of California Commercial |
$458.25
|
| Rate for Payer: Blue Shield of California EPN |
$332.38
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Central Health Plan Commercial |
$488.80
|
| Rate for Payer: Cigna of CA HMO |
$427.70
|
| Rate for Payer: Cigna of CA PPO |
$427.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$519.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$458.25
|
| Rate for Payer: IEHP medi-cal |
$213.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.51
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
| Rate for Payer: Riverside University Health MISP |
$244.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.50
|
| Rate for Payer: United Healthcare All Other HMO |
$305.50
|
| Rate for Payer: United Healthcare HMO Rider |
$305.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$305.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$519.35
|
| Rate for Payer: Vantage Medical Group Senior |
$519.35
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
905355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.45 |
| Max. Negotiated Rate |
$1,200.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,200.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$190.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.01
|
| Rate for Payer: BCBS Transplant Transplant |
$208.20
|
| Rate for Payer: Blue Shield of California Commercial |
$260.25
|
| Rate for Payer: Blue Shield of California EPN |
$188.77
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$260.25
|
| Rate for Payer: IEHP medi-cal |
$121.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.27
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Riverside University Health MISP |
$138.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.50
|
| Rate for Payer: United Healthcare All Other HMO |
$173.50
|
| Rate for Payer: United Healthcare HMO Rider |
$173.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC BK ADD SUPRACOND SUSPENS PTS
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT L5670
|
| Hospital Charge Code |
905355670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Blue Shield of California EPN |
$185.30
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
IP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
905355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Blue Shield of California EPN |
$379.14
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.00
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
|
|
HC BK ADD THIGH LACER NON-MOLDED
|
Facility
OP
|
$710.00
|
|
|
Service Code
|
CPT L5680
|
| Hospital Charge Code |
905355680
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$1,346.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,346.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$603.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$390.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$390.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$343.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$419.47
|
| Rate for Payer: BCBS Transplant Transplant |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$532.50
|
| Rate for Payer: Blue Shield of California EPN |
$386.24
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Central Health Plan Commercial |
$568.00
|
| Rate for Payer: Cigna of CA HMO |
$497.00
|
| Rate for Payer: Cigna of CA PPO |
$497.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$603.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$284.00
|
| Rate for Payer: Galaxy Health WC |
$603.50
|
| Rate for Payer: Global Benefits Group Commercial |
$426.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$532.50
|
| Rate for Payer: IEHP medi-cal |
$248.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$473.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.10
|
| Rate for Payer: Multiplan Commercial |
$532.50
|
| Rate for Payer: Networks By Design Commercial |
$355.00
|
| Rate for Payer: Prime Health Services Commercial |
$603.50
|
| Rate for Payer: Riverside University Health MISP |
$284.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$355.00
|
| Rate for Payer: United Healthcare All Other HMO |
$355.00
|
| Rate for Payer: United Healthcare HMO Rider |
$355.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$355.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$603.50
|
| Rate for Payer: Vantage Medical Group Senior |
$603.50
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
OP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
905355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$403.55 |
| Max. Negotiated Rate |
$2,766.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,766.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$980.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$634.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$634.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$558.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$681.19
|
| Rate for Payer: BCBS Transplant Transplant |
$691.80
|
| Rate for Payer: Blue Shield of California Commercial |
$864.75
|
| Rate for Payer: Blue Shield of California EPN |
$627.23
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Central Health Plan Commercial |
$922.40
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$980.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,037.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$864.75
|
| Rate for Payer: IEHP medi-cal |
$403.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.73
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: Riverside University Health MISP |
$461.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$576.50
|
| Rate for Payer: United Healthcare All Other HMO |
$576.50
|
| Rate for Payer: United Healthcare HMO Rider |
$576.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$980.05
|
| Rate for Payer: Vantage Medical Group Senior |
$980.05
|
|
|
HC BK ADD THIGH LCR GLUTEAL/ISCHI
|
Facility
IP
|
$1,153.00
|
|
|
Service Code
|
CPT L5682
|
| Hospital Charge Code |
905355682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$1,037.70 |
| Rate for Payer: Blue Shield of California EPN |
$615.70
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Central Health Plan Commercial |
$922.40
|
| Rate for Payer: Cigna of CA HMO |
$807.10
|
| Rate for Payer: Cigna of CA PPO |
$807.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$461.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.20
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,037.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.60
|
| Rate for Payer: Multiplan Commercial |
$864.75
|
| Rate for Payer: Networks By Design Commercial |
$576.50
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
905355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$432.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$432.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$136.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.11
|
| Rate for Payer: BCBS Transplant Transplant |
$149.40
|
| Rate for Payer: Blue Shield of California Commercial |
$186.75
|
| Rate for Payer: Blue Shield of California EPN |
$135.46
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$186.75
|
| Rate for Payer: IEHP medi-cal |
$87.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC BK ADD WAIST BELT PAD & LINED
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT L5690
|
| Hospital Charge Code |
905355690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Blue Shield of California EPN |
$132.97
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
OP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
905355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$867.30 |
| Max. Negotiated Rate |
$5,680.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,680.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,106.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,362.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,362.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,199.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,464.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,486.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,858.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,348.03
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,982.40
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,106.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,230.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,858.50
|
| Rate for Payer: IEHP medi-cal |
$867.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.98
|
| Rate for Payer: Multiplan Commercial |
$1,858.50
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
| Rate for Payer: Riverside University Health MISP |
$991.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,486.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,486.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,239.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,239.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,239.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,239.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,106.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,106.30
|
|
|
HC BK INITL PTB PLSTR SKT SACH FT
|
Facility
IP
|
$2,478.00
|
|
|
Service Code
|
CPT L5500
|
| Hospital Charge Code |
905355500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$495.60 |
| Max. Negotiated Rate |
$2,230.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,323.25
|
| Rate for Payer: Cash Price |
$1,115.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,982.40
|
| Rate for Payer: Cigna of CA HMO |
$1,734.60
|
| Rate for Payer: Cigna of CA PPO |
$1,734.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$991.20
|
| Rate for Payer: Galaxy Health WC |
$2,106.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,486.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,230.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,652.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.60
|
| Rate for Payer: Multiplan Commercial |
$1,858.50
|
| Rate for Payer: Networks By Design Commercial |
$1,239.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,106.30
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
IP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
905355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Blue Shield of California EPN |
$235.49
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC BK IPOP ADD CAST/ALIGN CHANGE
|
Facility
OP
|
$441.00
|
|
|
Service Code
|
CPT L5410
|
| Hospital Charge Code |
905355410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$1,848.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,848.01
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$242.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$242.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$213.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.54
|
| Rate for Payer: BCBS Transplant Transplant |
$264.60
|
| Rate for Payer: Blue Shield of California Commercial |
$330.75
|
| Rate for Payer: Blue Shield of California EPN |
$239.90
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Central Health Plan Commercial |
$352.80
|
| Rate for Payer: Cigna of CA HMO |
$308.70
|
| Rate for Payer: Cigna of CA PPO |
$308.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$396.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$330.75
|
| Rate for Payer: IEHP medi-cal |
$154.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.81
|
| Rate for Payer: Multiplan Commercial |
$330.75
|
| Rate for Payer: Networks By Design Commercial |
$220.50
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Riverside University Health MISP |
$176.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.50
|
| Rate for Payer: United Healthcare All Other HMO |
$220.50
|
| Rate for Payer: United Healthcare HMO Rider |
$220.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.85
|
| Rate for Payer: Vantage Medical Group Senior |
$374.85
|
|
