|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
IP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
905355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$352.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Blue Shield of California EPN |
$939.84
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,408.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,584.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$670.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.00
|
| Rate for Payer: Multiplan Commercial |
$1,320.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$664.58
|
| Rate for Payer: United Healthcare All Other HMO |
$649.09
|
| Rate for Payer: United Healthcare HMO Rider |
$635.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.80
|
|
|
HC BK IPOP INCLUDE 1 CAST CHANGE
|
Facility
|
OP
|
$1,760.00
|
|
|
Service Code
|
CPT L5400
|
| Hospital Charge Code |
905355400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$616.00 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$968.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$968.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$852.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,039.81
|
| Rate for Payer: Blue Distinction Transplant |
$1,056.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,320.00
|
| Rate for Payer: Blue Shield of California EPN |
$957.44
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,408.00
|
| Rate for Payer: Cigna of CA HMO |
$1,232.00
|
| Rate for Payer: Cigna of CA PPO |
$1,232.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,496.00
|
| Rate for Payer: Dignity Health Media |
$1,496.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$704.00
|
| Rate for Payer: Galaxy Health WC |
$1,496.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,056.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,584.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,320.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$616.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,173.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,269.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$721.60
|
| Rate for Payer: Multiplan Commercial |
$1,320.00
|
| Rate for Payer: Networks By Design Commercial |
$880.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,496.00
|
| Rate for Payer: Riverside University Health System MISP |
$704.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,056.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,056.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$880.00
|
| Rate for Payer: United Healthcare All Other HMO |
$880.00
|
| Rate for Payer: United Healthcare HMO Rider |
$880.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,496.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,496.00
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.55 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.79
|
| Rate for Payer: Blue Distinction Transplant |
$391.80
|
| Rate for Payer: Blue Shield of California Commercial |
$489.75
|
| Rate for Payer: Blue Shield of California EPN |
$355.23
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.05
|
| Rate for Payer: Dignity Health Media |
$555.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$489.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$228.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.73
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Riverside University Health System MISP |
$261.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$326.50
|
| Rate for Payer: United Healthcare All Other HMO |
$326.50
|
| Rate for Payer: United Healthcare HMO Rider |
$326.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$326.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.05
|
| Rate for Payer: Vantage Medical Group Senior |
$555.05
|
|
|
HC BK IPOP NON-WT BRNG RIGD DRESS
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT L5450
|
| Hospital Charge Code |
905355450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$587.70 |
| Rate for Payer: Blue Shield of California EPN |
$348.70
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Central Health Plan Commercial |
$522.40
|
| Rate for Payer: Cigna of CA HMO |
$457.10
|
| Rate for Payer: Cigna of CA PPO |
$457.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$587.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.60
|
| Rate for Payer: Multiplan Commercial |
$489.75
|
| Rate for Payer: Networks By Design Commercial |
$326.50
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.57
|
| Rate for Payer: United Healthcare All Other HMO |
$240.83
|
| Rate for Payer: United Healthcare HMO Rider |
$235.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.49
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
IP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
905355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,348.20 |
| Max. Negotiated Rate |
$6,066.90 |
| Rate for Payer: Blue Shield of California EPN |
$3,599.69
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,392.80
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,066.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,568.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.20
|
| Rate for Payer: Multiplan Commercial |
$5,055.75
|
| Rate for Payer: Networks By Design Commercial |
$3,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,545.40
|
| Rate for Payer: United Healthcare All Other HMO |
$2,486.08
|
| Rate for Payer: United Healthcare HMO Rider |
$2,432.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,224.53
|
|
|
HC BK MOLD SOCKET SHIN SACH FOOT
|
Facility
|
OP
|
$6,741.00
|
|
|
Service Code
|
CPT L5100
|
| Hospital Charge Code |
905355100
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,942.50 |
| Max. Negotiated Rate |
$6,066.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,707.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,707.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,263.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,982.58
|
| Rate for Payer: Blue Distinction Transplant |
$4,044.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,055.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,667.10
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Cash Price |
$3,033.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,392.80
|
| Rate for Payer: Cigna of CA HMO |
$4,718.70
|
| Rate for Payer: Cigna of CA PPO |
$4,718.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,729.85
|
| Rate for Payer: Dignity Health Media |
$5,729.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,729.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,696.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,696.40
|
| Rate for Payer: Galaxy Health WC |
$5,729.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,044.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,066.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,055.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,359.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,942.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,763.81
|
| Rate for Payer: Multiplan Commercial |
$5,055.75
|
| Rate for Payer: Networks By Design Commercial |
$3,370.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,729.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,696.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,044.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,044.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,370.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,370.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,370.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,370.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,729.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5,729.85
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
OP
|
$2,817.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
905355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$985.95 |
| Max. Negotiated Rate |
$2,535.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,549.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,549.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,363.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,664.28
|
| Rate for Payer: Blue Distinction Transplant |
$1,690.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,112.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,532.45
|
| Rate for Payer: Cash Price |
$1,267.65
|
| Rate for Payer: Cash Price |
$1,267.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,253.60
|
| Rate for Payer: Cigna of CA HMO |
$1,971.90
|
| Rate for Payer: Cigna of CA PPO |
$1,971.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,394.45
|
| Rate for Payer: Dignity Health Media |
$2,394.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,394.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,126.80
|
| Rate for Payer: Galaxy Health WC |
$2,394.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,690.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,535.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,112.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$985.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,878.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,299.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,154.97
|
| Rate for Payer: Multiplan Commercial |
$2,112.75
|
| Rate for Payer: Networks By Design Commercial |
$1,408.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,394.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,126.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,690.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,690.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,408.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,408.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,408.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,408.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,394.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,394.45
|
|
|
HC BK PREPARATORY PTB PRE-FAB
|
Facility
|
IP
|
$2,817.00
|
|
|
Service Code
|
CPT L5535
|
| Hospital Charge Code |
905355535
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$563.40 |
| Max. Negotiated Rate |
$2,535.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,504.28
|
| Rate for Payer: Cash Price |
$1,267.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,253.60
|
| Rate for Payer: Cigna of CA HMO |
$1,971.90
|
| Rate for Payer: Cigna of CA PPO |
$1,971.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,126.80
|
| Rate for Payer: Galaxy Health WC |
$2,394.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,690.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,535.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,878.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,073.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.40
|
| Rate for Payer: Multiplan Commercial |
$2,112.75
|
| Rate for Payer: Networks By Design Commercial |
$1,408.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,394.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,038.91
|
| Rate for Payer: United Healthcare HMO Rider |
$1,016.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$929.61
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
OP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
905355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,300.95 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,044.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,044.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,799.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,196.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,230.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,787.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,022.05
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,159.45
|
| Rate for Payer: Dignity Health Media |
$3,159.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,159.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,787.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,300.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,099.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.97
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$1,858.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,486.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,230.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,230.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,858.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,858.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,858.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,159.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,159.45
|
|
|
HC BK PREP PTB CUSTOM PLAST SOCKT
|
Facility
|
IP
|
$3,717.00
|
|
|
Service Code
|
CPT L5530
|
| Hospital Charge Code |
905355530
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$743.40 |
| Max. Negotiated Rate |
$3,345.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,984.88
|
| Rate for Payer: Cash Price |
$1,672.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,973.60
|
| Rate for Payer: Cigna of CA HMO |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,486.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,486.80
|
| Rate for Payer: Galaxy Health WC |
$3,159.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,230.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,345.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,479.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,416.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.40
|
| Rate for Payer: Multiplan Commercial |
$2,787.75
|
| Rate for Payer: Networks By Design Commercial |
$1,858.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,159.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,403.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,370.83
|
| Rate for Payer: United Healthcare HMO Rider |
$1,341.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,226.61
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
OP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
905355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,450.05 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,278.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,006.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,447.68
|
| Rate for Payer: Blue Distinction Transplant |
$2,485.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,107.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,253.79
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,521.55
|
| Rate for Payer: Dignity Health Media |
$3,521.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,521.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,107.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,763.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,023.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,698.63
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,071.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,657.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,485.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,485.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,071.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,071.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,071.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,071.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,521.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,521.55
|
|
|
HC BK PREP PTB LAMINATED SOCKET
|
Facility
|
IP
|
$4,143.00
|
|
|
Service Code
|
CPT L5540
|
| Hospital Charge Code |
905355540
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$828.60 |
| Max. Negotiated Rate |
$3,728.70 |
| Rate for Payer: Blue Shield of California EPN |
$2,212.36
|
| Rate for Payer: Cash Price |
$1,864.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,314.40
|
| Rate for Payer: Cigna of CA HMO |
$2,900.10
|
| Rate for Payer: Cigna of CA PPO |
$2,900.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,657.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,657.20
|
| Rate for Payer: Galaxy Health WC |
$3,521.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,485.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,728.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,763.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,578.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.60
|
| Rate for Payer: Multiplan Commercial |
$3,107.25
|
| Rate for Payer: Networks By Design Commercial |
$2,071.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,521.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,564.40
|
| Rate for Payer: United Healthcare All Other HMO |
$1,527.94
|
| Rate for Payer: United Healthcare HMO Rider |
$1,494.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.19
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
OP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
905355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,093.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,093.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$962.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,174.51
|
| Rate for Payer: Blue Distinction Transplant |
$1,192.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,491.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,081.47
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,689.80
|
| Rate for Payer: Dignity Health Media |
$1,689.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,689.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,491.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$695.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$815.08
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: Riverside University Health System MISP |
$795.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,192.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,192.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$994.00
|
| Rate for Payer: United Healthcare All Other HMO |
$994.00
|
| Rate for Payer: United Healthcare HMO Rider |
$994.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$994.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,689.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,689.80
|
|
|
HC BK PREP PTB THERMOPLSTIC SOCKT
|
Facility
|
IP
|
$1,988.00
|
|
|
Service Code
|
CPT L5520
|
| Hospital Charge Code |
905355520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$397.60 |
| Max. Negotiated Rate |
$1,789.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,061.59
|
| Rate for Payer: Cash Price |
$894.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,590.40
|
| Rate for Payer: Cigna of CA HMO |
$1,391.60
|
| Rate for Payer: Cigna of CA PPO |
$1,391.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$795.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$795.20
|
| Rate for Payer: Galaxy Health WC |
$1,689.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,192.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,789.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$757.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.60
|
| Rate for Payer: Multiplan Commercial |
$1,491.00
|
| Rate for Payer: Networks By Design Commercial |
$994.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,689.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$750.67
|
| Rate for Payer: United Healthcare All Other HMO |
$733.17
|
| Rate for Payer: United Healthcare HMO Rider |
$717.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$656.04
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$520.10 |
| Max. Negotiated Rate |
$1,492.94 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$817.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$719.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$877.93
|
| Rate for Payer: Blue Distinction Transplant |
$891.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,114.50
|
| Rate for Payer: Blue Shield of California EPN |
$808.38
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Dignity Health Media |
$1,263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,114.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$520.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,492.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$609.26
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$743.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: Riverside University Health System MISP |
$594.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$743.00
|
| Rate for Payer: United Healthcare All Other HMO |
$743.00
|
| Rate for Payer: United Healthcare HMO Rider |
$743.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.10
|
|
|
HC BK PREPRTORY PTB PLASTER SOCKT
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
CPT L5510
|
| Hospital Charge Code |
905355510
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,337.40 |
| Rate for Payer: Blue Shield of California EPN |
$793.52
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$1,040.20
|
| Rate for Payer: Cigna of CA PPO |
$1,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$743.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.11
|
| Rate for Payer: United Healthcare All Other HMO |
$548.04
|
| Rate for Payer: United Healthcare HMO Rider |
$536.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$490.38
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,047.40 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Blue Shield of California EPN |
$2,796.56
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,995.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,047.40
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,977.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,931.41
|
| Rate for Payer: United Healthcare HMO Rider |
$1,889.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.21
|
|
|
HC BK PROS MID SKT ENDO NO-COVER
|
Facility
|
OP
|
$5,237.00
|
|
|
Service Code
|
CPT L5301
|
| Hospital Charge Code |
905355301
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,832.95 |
| Max. Negotiated Rate |
$4,713.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,880.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,880.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,535.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,094.02
|
| Rate for Payer: Blue Distinction Transplant |
$3,142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,927.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,848.93
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Cash Price |
$2,356.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,189.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.90
|
| Rate for Payer: Cigna of CA PPO |
$3,665.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,451.45
|
| Rate for Payer: Dignity Health Media |
$4,451.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,451.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,094.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,094.80
|
| Rate for Payer: Galaxy Health WC |
$4,451.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,142.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,713.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,927.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,832.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,493.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,715.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.17
|
| Rate for Payer: Multiplan Commercial |
$3,927.75
|
| Rate for Payer: Networks By Design Commercial |
$2,618.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,451.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,094.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,142.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,142.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,618.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,618.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,618.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,618.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,451.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,451.45
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$366.80 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$576.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$507.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$619.16
|
| Rate for Payer: Blue Distinction Transplant |
$628.80
|
| Rate for Payer: Blue Shield of California Commercial |
$786.00
|
| Rate for Payer: Blue Shield of California EPN |
$570.11
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Media |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$786.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$366.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.68
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Riverside University Health System MISP |
$419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$524.00
|
| Rate for Payer: United Healthcare All Other HMO |
$524.00
|
| Rate for Payer: United Healthcare HMO Rider |
$524.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC BK REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT L5704
|
| Hospital Charge Code |
905355704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Blue Shield of California EPN |
$559.63
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$524.00
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.72
|
| Rate for Payer: United Healthcare All Other HMO |
$386.50
|
| Rate for Payer: United Healthcare HMO Rider |
$378.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$345.84
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
IP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
905355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,254.60 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Blue Shield of California EPN |
$3,349.78
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,390.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.60
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,368.68
|
| Rate for Payer: United Healthcare All Other HMO |
$2,313.48
|
| Rate for Payer: United Healthcare HMO Rider |
$2,263.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,070.09
|
|
|
HC BK REPLACEMENT OF SOCKET
|
Facility
|
OP
|
$6,273.00
|
|
|
Service Code
|
CPT L5700
|
| Hospital Charge Code |
905355700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,195.55 |
| Max. Negotiated Rate |
$5,645.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,450.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,450.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,037.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,706.09
|
| Rate for Payer: Blue Distinction Transplant |
$3,763.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,704.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,412.51
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Cash Price |
$2,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,018.40
|
| Rate for Payer: Cigna of CA HMO |
$4,391.10
|
| Rate for Payer: Cigna of CA PPO |
$4,391.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,332.05
|
| Rate for Payer: Dignity Health Media |
$5,332.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,332.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,509.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,509.20
|
| Rate for Payer: Galaxy Health WC |
$5,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,645.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,704.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,195.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,184.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,087.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,571.93
|
| Rate for Payer: Multiplan Commercial |
$4,704.75
|
| Rate for Payer: Networks By Design Commercial |
$3,136.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,332.05
|
| Rate for Payer: Riverside University Health System MISP |
$2,509.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,136.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,332.05
|
| Rate for Payer: Vantage Medical Group Senior |
$5,332.05
|
|
|
HC BK SHRINKER
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.54
|
| Rate for Payer: Blue Distinction Transplant |
$56.40
|
| Rate for Payer: Blue Shield of California Commercial |
$70.50
|
| Rate for Payer: Blue Shield of California EPN |
$51.14
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Media |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$70.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Riverside University Health System MISP |
$37.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.00
|
| Rate for Payer: United Healthcare All Other HMO |
$47.00
|
| Rate for Payer: United Healthcare HMO Rider |
$47.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC BK SHRINKER
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
905358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Blue Shield of California EPN |
$50.20
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.49
|
| Rate for Payer: United Healthcare All Other HMO |
$34.67
|
| Rate for Payer: United Healthcare HMO Rider |
$33.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.02
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$169.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: Blue Distinction Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$104.44
|
| Rate for Payer: Blue Shield of California EPN |
$82.13
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
