|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$834.14 |
| Max. Negotiated Rate |
$2,292.30 |
| Rate for Payer: Adventist Health Commercial |
$1,044.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,910.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,495.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,968.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,283.69
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,037.60
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,164.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,292.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,186.85
|
| Rate for Payer: InnovAge PACE Commercial |
$1,273.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,044.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,782.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,782.90
|
| Rate for Payer: Multiplan Commercial |
$1,910.25
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Riverside University Health System MISP |
$1,018.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,081.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.60
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,750.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
915355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,081.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.60
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,750.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
915355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$881.96 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Adventist Health Commercial |
$1,104.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,481.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,581.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,081.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,289.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,119.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,346.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,885.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,885.10
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,077.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.05
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$881.96 |
| Max. Negotiated Rate |
$2,423.70 |
| Rate for Payer: Adventist Health Commercial |
$1,104.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,481.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,581.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,081.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,357.27
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,154.40
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,289.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,423.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,119.67
|
| Rate for Payer: InnovAge PACE Commercial |
$1,346.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,885.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,885.10
|
| Rate for Payer: Multiplan Commercial |
$2,019.75
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,077.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.05
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
915355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Blue Shield of California Commercial |
$634.63
|
| Rate for Payer: Blue Shield of California EPN |
$413.78
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.20
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$268.88 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Adventist Health Commercial |
$336.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$482.17
|
| Rate for Payer: Blue Shield of California Commercial |
$634.63
|
| Rate for Payer: Blue Shield of California EPN |
$413.78
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.22
|
| Rate for Payer: InnovAge PACE Commercial |
$410.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$574.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$574.70
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Riverside University Health System MISP |
$328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Blue Shield of California Commercial |
$634.63
|
| Rate for Payer: Blue Shield of California EPN |
$413.78
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.20
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
915355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$268.88 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Adventist Health Commercial |
$336.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$482.17
|
| Rate for Payer: Blue Shield of California Commercial |
$634.63
|
| Rate for Payer: Blue Shield of California EPN |
$413.78
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$315.22
|
| Rate for Payer: InnovAge PACE Commercial |
$410.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$574.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$574.70
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Riverside University Health System MISP |
$328.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
915355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
915355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.99 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.54
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.45
|
| Rate for Payer: InnovAge PACE Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health System MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.99 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.54
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$299.45
|
| Rate for Payer: InnovAge PACE Commercial |
$372.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health System MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Blue Shield of California Commercial |
$575.88
|
| Rate for Payer: Blue Shield of California EPN |
$375.48
|
| Rate for Payer: Cash Price |
$409.75
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
OP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,016.65 |
| Max. Negotiated Rate |
$13,786.20 |
| Rate for Payer: Adventist Health Commercial |
$6,280.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,424.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,488.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,996.26
|
| Rate for Payer: Blue Shield of California Commercial |
$11,840.81
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.27
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,254.40
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,020.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,020.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,786.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,426.49
|
| Rate for Payer: InnovAge PACE Commercial |
$7,659.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,280.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,722.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,722.60
|
| Rate for Payer: Multiplan Commercial |
$11,488.50
|
| Rate for Payer: Networks By Design Commercial |
$7,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: Riverside University Health System MISP |
$6,127.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13,020.30
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,063.60 |
| Max. Negotiated Rate |
$13,786.20 |
| Rate for Payer: Adventist Health Commercial |
$3,063.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11,840.81
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.27
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,254.40
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,786.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,836.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,063.60
|
| Rate for Payer: Multiplan Commercial |
$11,488.50
|
| Rate for Payer: Networks By Design Commercial |
$9,956.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,063.60 |
| Max. Negotiated Rate |
$13,786.20 |
| Rate for Payer: Adventist Health Commercial |
$3,063.60
|
| Rate for Payer: Blue Shield of California Commercial |
$11,840.81
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.27
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,254.40
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,786.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,836.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,063.60
|
| Rate for Payer: Multiplan Commercial |
$11,488.50
|
| Rate for Payer: Networks By Design Commercial |
$9,956.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
OP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,016.65 |
| Max. Negotiated Rate |
$13,786.20 |
| Rate for Payer: Adventist Health Commercial |
$6,280.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,424.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,488.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,996.26
|
| Rate for Payer: Blue Shield of California Commercial |
$11,840.81
|
| Rate for Payer: Blue Shield of California EPN |
$7,720.27
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Cash Price |
$8,424.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,254.40
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,020.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,020.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,786.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,426.49
|
| Rate for Payer: InnovAge PACE Commercial |
$7,659.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,217.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,481.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,280.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,722.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,722.60
|
| Rate for Payer: Multiplan Commercial |
$11,488.50
|
| Rate for Payer: Networks By Design Commercial |
$7,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: Riverside University Health System MISP |
$6,127.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13,020.30
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
IP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
915355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,910.20 |
| Max. Negotiated Rate |
$17,595.90 |
| Rate for Payer: Adventist Health Commercial |
$3,910.20
|
| Rate for Payer: Blue Shield of California Commercial |
$15,112.92
|
| Rate for Payer: Blue Shield of California EPN |
$9,853.70
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,640.80
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,595.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,448.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,910.20
|
| Rate for Payer: Multiplan Commercial |
$14,663.25
|
| Rate for Payer: Networks By Design Commercial |
$12,708.15
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
IP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
905355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,910.20 |
| Max. Negotiated Rate |
$17,595.90 |
| Rate for Payer: Adventist Health Commercial |
$3,910.20
|
| Rate for Payer: Blue Shield of California Commercial |
$15,112.92
|
| Rate for Payer: Blue Shield of California EPN |
$9,853.70
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,640.80
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,595.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,448.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,910.20
|
| Rate for Payer: Multiplan Commercial |
$14,663.25
|
| Rate for Payer: Networks By Design Commercial |
$12,708.15
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
OP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
905355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,583.79 |
| Max. Negotiated Rate |
$17,595.90 |
| Rate for Payer: Adventist Health Commercial |
$8,015.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,753.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,663.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,482.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15,112.92
|
| Rate for Payer: Blue Shield of California EPN |
$9,853.70
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,640.80
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,618.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,618.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,595.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,583.79
|
| Rate for Payer: InnovAge PACE Commercial |
$9,775.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,958.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,015.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,685.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,685.70
|
| Rate for Payer: Multiplan Commercial |
$14,663.25
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,820.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,730.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,730.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16,618.35
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
|
OP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
915355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,583.79 |
| Max. Negotiated Rate |
$17,595.90 |
| Rate for Payer: Adventist Health Commercial |
$8,015.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,753.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,663.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,482.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15,112.92
|
| Rate for Payer: Blue Shield of California EPN |
$9,853.70
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Cash Price |
$10,753.05
|
| Rate for Payer: Central Health Plan Commercial |
$15,640.80
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,618.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,618.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,595.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,583.79
|
| Rate for Payer: InnovAge PACE Commercial |
$9,775.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,958.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,102.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,015.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13,685.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13,685.70
|
| Rate for Payer: Multiplan Commercial |
$14,663.25
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: Riverside University Health System MISP |
$7,820.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,730.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,730.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,337.49
|
| Rate for Payer: United Healthcare All Other HMO |
$7,141.98
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,402.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16,618.35
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
OP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
915355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,863.66 |
| Max. Negotiated Rate |
$7,869.60 |
| Rate for Payer: Adventist Health Commercial |
$3,585.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,809.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,135.35
|
| Rate for Payer: Blue Shield of California Commercial |
$6,759.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,406.98
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,995.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,432.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,432.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,869.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,899.60
|
| Rate for Payer: InnovAge PACE Commercial |
$4,372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,517.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,585.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,120.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,120.80
|
| Rate for Payer: Multiplan Commercial |
$6,558.00
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: Riverside University Health System MISP |
$3,497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,432.40
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
IP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
915355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$7,869.60 |
| Rate for Payer: Adventist Health Commercial |
$1,748.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,759.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,406.98
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,995.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,869.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,331.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,748.80
|
| Rate for Payer: Multiplan Commercial |
$6,558.00
|
| Rate for Payer: Networks By Design Commercial |
$5,683.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
IP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
905355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$7,869.60 |
| Rate for Payer: Adventist Health Commercial |
$1,748.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,759.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,406.98
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,995.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,869.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,331.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,748.80
|
| Rate for Payer: Multiplan Commercial |
$6,558.00
|
| Rate for Payer: Networks By Design Commercial |
$5,683.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
|
OP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
905355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,863.66 |
| Max. Negotiated Rate |
$7,869.60 |
| Rate for Payer: Adventist Health Commercial |
$3,585.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,809.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,558.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,135.35
|
| Rate for Payer: Blue Shield of California Commercial |
$6,759.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,406.98
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Cash Price |
$4,809.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,995.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,432.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,432.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,869.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,899.60
|
| Rate for Payer: InnovAge PACE Commercial |
$4,372.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,517.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,412.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,585.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,120.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,120.80
|
| Rate for Payer: Multiplan Commercial |
$6,558.00
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: Riverside University Health System MISP |
$3,497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,281.62
|
| Rate for Payer: United Healthcare All Other HMO |
$3,194.18
|
| Rate for Payer: United Healthcare HMO Rider |
$3,125.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,863.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,432.40
|
|
