|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.59 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$286.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.03
|
| Rate for Payer: Blue Shield of California Commercial |
$559.80
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$593.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$257.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.96
|
| Rate for Payer: United Healthcare All Other HMO |
$254.98
|
| Rate for Payer: United Healthcare HMO Rider |
$249.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
915355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Blue Shield of California Commercial |
$769.12
|
| Rate for Payer: Blue Shield of California EPN |
$483.34
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Blue Shield of California Commercial |
$769.12
|
| Rate for Payer: Blue Shield of California EPN |
$483.34
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
905355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.85 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.85
|
| Rate for Payer: Blue Shield of California Commercial |
$769.12
|
| Rate for Payer: Blue Shield of California EPN |
$483.34
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Riverside University Health System MISP |
$383.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC KD ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT L5656
|
| Hospital Charge Code |
915355656
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$235.85 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Networks By Design Commercial |
$479.50
|
| Rate for Payer: Adventist Health Commercial |
$393.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$527.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$557.85
|
| Rate for Payer: Blue Shield of California Commercial |
$769.12
|
| Rate for Payer: Blue Shield of California EPN |
$483.34
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$671.30
|
| Rate for Payer: Cigna of CA PPO |
$671.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$815.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$815.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$815.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$671.30
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Riverside University Health System MISP |
$383.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.91
|
| Rate for Payer: United Healthcare All Other HMO |
$350.32
|
| Rate for Payer: United Healthcare HMO Rider |
$342.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$314.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$815.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$815.15
|
| Rate for Payer: Vantage Medical Group Senior |
$815.15
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
IP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
915355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.20 |
| Max. Negotiated Rate |
$13,500.90 |
| Rate for Payer: Adventist Health Commercial |
$3,000.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,030.80
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.50
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.80
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.20
|
| Rate for Payer: Multiplan Commercial |
$11,250.75
|
| Rate for Payer: Networks By Design Commercial |
$9,750.65
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
OP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
915355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,353.29 |
| Max. Negotiated Rate |
$13,500.90 |
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.85
|
| Rate for Payer: Adventist Health Commercial |
$6,150.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,726.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12,030.80
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.50
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.80
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,353.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,500.70
|
| Rate for Payer: Multiplan Commercial |
$11,250.75
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: Riverside University Health System MISP |
$6,000.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.85
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
IP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,000.20 |
| Max. Negotiated Rate |
$13,500.90 |
| Rate for Payer: Adventist Health Commercial |
$3,000.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,030.80
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.50
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.80
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,000.20
|
| Rate for Payer: Multiplan Commercial |
$11,250.75
|
| Rate for Payer: Networks By Design Commercial |
$9,750.65
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
|
|
HC KD BENT KNEE SACH FOOT
|
Facility
|
OP
|
$15,001.00
|
|
|
Service Code
|
CPT L5160
|
| Hospital Charge Code |
905355160
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,353.29 |
| Max. Negotiated Rate |
$13,500.90 |
| Rate for Payer: Adventist Health Commercial |
$6,150.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,250.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,250.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,726.08
|
| Rate for Payer: Blue Shield of California Commercial |
$12,030.80
|
| Rate for Payer: Blue Shield of California EPN |
$7,560.50
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Cash Price |
$6,750.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,000.80
|
| Rate for Payer: Cigna of CA HMO |
$10,500.70
|
| Rate for Payer: Cigna of CA PPO |
$10,500.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,750.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,750.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,500.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,000.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,000.40
|
| Rate for Payer: Galaxy Health WC |
$12,750.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,000.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,500.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,353.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,525.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,850.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,500.70
|
| Rate for Payer: Multiplan Commercial |
$11,250.75
|
| Rate for Payer: Networks By Design Commercial |
$7,500.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,750.85
|
| Rate for Payer: Riverside University Health System MISP |
$6,000.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,000.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,000.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,629.88
|
| Rate for Payer: United Healthcare All Other HMO |
$5,479.87
|
| Rate for Payer: United Healthcare HMO Rider |
$5,361.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,912.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,750.85
|
| Rate for Payer: Vantage Medical Group Senior |
$12,750.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,844.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.20
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$6,357.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
915355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,457.17 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Adventist Health Commercial |
$4,010.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,689.61
|
| Rate for Payer: Blue Shield of California Commercial |
$7,844.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,313.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,457.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,010.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,846.70
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,912.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
OP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,457.17 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Adventist Health Commercial |
$4,010.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,379.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,335.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,689.61
|
| Rate for Payer: Blue Shield of California Commercial |
$7,844.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,313.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,313.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,457.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,010.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,846.70
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$4,890.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,912.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,868.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,868.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,313.85
|
| Rate for Payer: Vantage Medical Group Senior |
$8,313.85
|
|
|
HC KD MLD SOKT EXT KNEE JTS SACH
|
Facility
|
IP
|
$9,781.00
|
|
|
Service Code
|
CPT L5150
|
| Hospital Charge Code |
905355150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,956.20 |
| Max. Negotiated Rate |
$8,802.90 |
| Rate for Payer: Adventist Health Commercial |
$1,956.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,844.36
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$4,401.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,824.80
|
| Rate for Payer: Cigna of CA HMO |
$6,846.70
|
| Rate for Payer: Cigna of CA PPO |
$6,846.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,846.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,912.40
|
| Rate for Payer: Galaxy Health WC |
$8,313.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,868.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,802.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,210.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,770.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.20
|
| Rate for Payer: Multiplan Commercial |
$7,335.75
|
| Rate for Payer: Networks By Design Commercial |
$6,357.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,313.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,670.81
|
| Rate for Payer: United Healthcare All Other HMO |
$3,573.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,495.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,203.28
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
IP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,074.60 |
| Max. Negotiated Rate |
$13,835.70 |
| Rate for Payer: Adventist Health Commercial |
$3,074.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12,329.15
|
| Rate for Payer: Blue Shield of California EPN |
$7,747.99
|
| Rate for Payer: Cash Price |
$6,917.85
|
| Rate for Payer: Central Health Plan Commercial |
$12,298.40
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,761.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,835.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,761.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,070.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,074.60
|
| Rate for Payer: Multiplan Commercial |
$11,529.75
|
| Rate for Payer: Networks By Design Commercial |
$9,992.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
|
|
HC KD MOLD SKT SACH ENDO SFT COVR
|
Facility
|
OP
|
$15,373.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5,034.66 |
| Max. Negotiated Rate |
$13,835.70 |
| Rate for Payer: Adventist Health Commercial |
$6,302.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,455.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,529.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,942.47
|
| Rate for Payer: Blue Shield of California Commercial |
$12,329.15
|
| Rate for Payer: Blue Shield of California EPN |
$7,747.99
|
| Rate for Payer: Cash Price |
$6,917.85
|
| Rate for Payer: Central Health Plan Commercial |
$12,298.40
|
| Rate for Payer: Cigna of CA HMO |
$10,761.10
|
| Rate for Payer: Cigna of CA PPO |
$10,761.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,067.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,067.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,761.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,149.20
|
| Rate for Payer: Galaxy Health WC |
$13,067.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,835.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,761.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,580.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,070.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,302.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,761.10
|
| Rate for Payer: Multiplan Commercial |
$11,529.75
|
| Rate for Payer: Networks By Design Commercial |
$7,686.50
|
| Rate for Payer: Prime Health Services Commercial |
$13,067.05
|
| Rate for Payer: Riverside University Health System MISP |
$6,149.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,223.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,769.49
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.76
|
| Rate for Payer: United Healthcare HMO Rider |
$5,494.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,034.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,067.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13,067.05
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$404.13 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.82
|
| Rate for Payer: Blue Shield of California Commercial |
$989.67
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$759.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Riverside University Health System MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
915355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Blue Shield of California Commercial |
$989.67
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Blue Shield of California Commercial |
$989.67
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
|
|
HC KD REPLACEMENT OF SHAPED COVER
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT L5706
|
| Hospital Charge Code |
905355706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$404.13 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Adventist Health Commercial |
$505.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$925.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$717.82
|
| Rate for Payer: Blue Shield of California Commercial |
$989.67
|
| Rate for Payer: Blue Shield of California EPN |
$621.94
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$863.80
|
| Rate for Payer: Cigna of CA PPO |
$863.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,048.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$863.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$759.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$783.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$839.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$728.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$863.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$617.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Riverside University Health System MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$463.12
|
| Rate for Payer: United Healthcare All Other HMO |
$450.78
|
| Rate for Payer: United Healthcare HMO Rider |
$441.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$132.46 |
| Max. Negotiated Rate |
$1,261.80 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$815.54
|
| Rate for Payer: Blue Shield of California Commercial |
$883.26
|
| Rate for Payer: Blue Shield of California EPN |
$556.59
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,121.60
|
| Rate for Payer: Cigna of CA HMO |
$897.28
|
| Rate for Payer: Cigna of CA PPO |
$1,037.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$981.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,191.70
|
| Rate for Payer: Global Benefits Group Commercial |
$841.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,261.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$890.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
| Rate for Payer: Networks By Design Commercial |
$911.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,191.70
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$841.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$841.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,402.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$280.40 |
| Max. Negotiated Rate |
$1,261.80 |
| Rate for Payer: Adventist Health Commercial |
$280.40
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,121.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$981.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.80
|
| Rate for Payer: EPIC Health Plan Senior |
$560.80
|
| Rate for Payer: Galaxy Health WC |
$1,191.70
|
| Rate for Payer: Global Benefits Group Commercial |
$841.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,261.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$890.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$827.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.40
|
| Rate for Payer: Multiplan Commercial |
$1,051.50
|
| Rate for Payer: Networks By Design Commercial |
$911.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,191.70
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$2,189.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$437.80 |
| Max. Negotiated Rate |
$1,970.10 |
| Rate for Payer: Adventist Health Commercial |
$437.80
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,751.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,532.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$875.60
|
| Rate for Payer: EPIC Health Plan Senior |
$875.60
|
| Rate for Payer: Galaxy Health WC |
$1,860.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,313.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,970.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,390.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,291.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.80
|
| Rate for Payer: Multiplan Commercial |
$1,641.75
|
| Rate for Payer: Networks By Design Commercial |
$1,422.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,860.65
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$2,189.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$206.11 |
| Max. Negotiated Rate |
$1,970.10 |
| Rate for Payer: Adventist Health Commercial |
$437.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,197.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$731.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,273.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,379.07
|
| Rate for Payer: Blue Shield of California EPN |
$869.03
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,751.20
|
| Rate for Payer: Cigna of CA HMO |
$1,400.96
|
| Rate for Payer: Cigna of CA PPO |
$1,619.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,532.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,860.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,313.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,970.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$206.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,390.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,641.75
|
| Rate for Payer: Networks By Design Commercial |
$1,422.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$1,860.65
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,313.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,313.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC KIT, ADULT CENTRAL LINE DRES CHANGE
|
Facility
|
OP
|
$194.81
|
|
| Hospital Charge Code |
901607207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$175.33 |
| Rate for Payer: Adventist Health Commercial |
$38.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$165.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.32
|
| Rate for Payer: Blue Shield of California Commercial |
$123.51
|
| Rate for Payer: Blue Shield of California EPN |
$77.73
|
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: Central Health Plan Commercial |
$155.85
|
| Rate for Payer: Cigna of CA HMO |
$124.68
|
| Rate for Payer: Cigna of CA PPO |
$144.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$165.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$165.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.92
|
| Rate for Payer: EPIC Health Plan Senior |
$77.92
|
| Rate for Payer: Galaxy Health WC |
$165.59
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$136.37
|
| Rate for Payer: Multiplan Commercial |
$146.11
|
| Rate for Payer: Networks By Design Commercial |
$126.63
|
| Rate for Payer: Prime Health Services Commercial |
$165.59
|
| Rate for Payer: Riverside University Health System MISP |
$77.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.41
|
| Rate for Payer: United Healthcare All Other HMO |
$97.41
|
| Rate for Payer: United Healthcare HMO Rider |
$97.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$165.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$165.59
|
| Rate for Payer: Vantage Medical Group Senior |
$165.59
|
|
|
HC KIT, ADULT CENTRAL LINE DRES CHANGE
|
Facility
|
IP
|
$194.81
|
|
| Hospital Charge Code |
901607207
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.96 |
| Max. Negotiated Rate |
$175.33 |
| Rate for Payer: Adventist Health Commercial |
$38.96
|
| Rate for Payer: Cash Price |
$87.66
|
| Rate for Payer: Central Health Plan Commercial |
$155.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$136.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.92
|
| Rate for Payer: EPIC Health Plan Senior |
$77.92
|
| Rate for Payer: Galaxy Health WC |
$165.59
|
| Rate for Payer: Global Benefits Group Commercial |
$116.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$175.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$123.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.96
|
| Rate for Payer: Multiplan Commercial |
$146.11
|
| Rate for Payer: Networks By Design Commercial |
$126.63
|
| Rate for Payer: Prime Health Services Commercial |
$165.59
|
|
