|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.08 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$111.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$149.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.75
|
| Rate for Payer: Blue Shield of California Commercial |
$210.26
|
| Rate for Payer: Blue Shield of California EPN |
$137.09
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$231.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$231.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.29
|
| Rate for Payer: InnovAge PACE Commercial |
$136.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$190.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$136.00
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: Riverside University Health System MISP |
$108.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$231.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$231.20
|
| Rate for Payer: Vantage Medical Group Senior |
$231.20
|
|
|
HC KAFO STATIC PLASTIC PEDIATRIC PREFAB
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT L2035
|
| Hospital Charge Code |
915352035
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$54.40
|
| Rate for Payer: Blue Shield of California Commercial |
$210.26
|
| Rate for Payer: Blue Shield of California EPN |
$137.09
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Central Health Plan Commercial |
$217.60
|
| Rate for Payer: Cigna of CA HMO |
$190.40
|
| Rate for Payer: Cigna of CA PPO |
$190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.80
|
| Rate for Payer: EPIC Health Plan Senior |
$108.80
|
| Rate for Payer: Galaxy Health WC |
$231.20
|
| Rate for Payer: Global Benefits Group Commercial |
$163.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Networks By Design Commercial |
$176.80
|
| Rate for Payer: Prime Health Services Commercial |
$231.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.08
|
| Rate for Payer: United Healthcare All Other HMO |
$99.36
|
| Rate for Payer: United Healthcare HMO Rider |
$97.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.08
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.85 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.57
|
| Rate for Payer: Blue Shield of California Commercial |
$549.60
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$692.54
|
| Rate for Payer: InnovAge PACE Commercial |
$355.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Riverside University Health System MISP |
$284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$549.60
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
915355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.85 |
| Max. Negotiated Rate |
$765.02 |
| Rate for Payer: Adventist Health Commercial |
$291.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$533.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.57
|
| Rate for Payer: Blue Shield of California Commercial |
$549.60
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$604.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$604.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$604.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$692.54
|
| Rate for Payer: InnovAge PACE Commercial |
$355.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$497.70
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$355.50
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: Riverside University Health System MISP |
$284.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$426.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$426.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$604.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$604.35
|
| Rate for Payer: Vantage Medical Group Senior |
$604.35
|
|
|
HC KD ADD EXPANDIBLE WALL SOCKET
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT L5653
|
| Hospital Charge Code |
905355653
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.20 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Adventist Health Commercial |
$142.20
|
| Rate for Payer: Blue Shield of California Commercial |
$549.60
|
| Rate for Payer: Blue Shield of California EPN |
$358.34
|
| Rate for Payer: Cash Price |
$319.95
|
| Rate for Payer: Central Health Plan Commercial |
$568.80
|
| Rate for Payer: Cigna of CA HMO |
$497.70
|
| Rate for Payer: Cigna of CA PPO |
$497.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.40
|
| Rate for Payer: EPIC Health Plan Senior |
$284.40
|
| Rate for Payer: Galaxy Health WC |
$604.35
|
| Rate for Payer: Global Benefits Group Commercial |
$426.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$639.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$474.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$440.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.20
|
| Rate for Payer: Multiplan Commercial |
$533.25
|
| Rate for Payer: Networks By Design Commercial |
$462.15
|
| Rate for Payer: Prime Health Services Commercial |
$604.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$266.84
|
| Rate for Payer: United Healthcare All Other HMO |
$259.73
|
| Rate for Payer: United Healthcare HMO Rider |
$254.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$232.85
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.31 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$730.60
|
| Rate for Payer: Blue Shield of California Commercial |
$961.61
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.31
|
| Rate for Payer: InnovAge PACE Commercial |
$622.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$870.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Riverside University Health System MISP |
$497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Blue Shield of California Commercial |
$961.61
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
915355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Blue Shield of California Commercial |
$961.61
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
|
|
HC KD ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT L5640
|
| Hospital Charge Code |
905355640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$231.31 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$510.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$684.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$730.60
|
| Rate for Payer: Blue Shield of California Commercial |
$961.61
|
| Rate for Payer: Blue Shield of California EPN |
$626.98
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Cash Price |
$559.80
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$870.80
|
| Rate for Payer: Cigna of CA PPO |
$870.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,057.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,057.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.31
|
| Rate for Payer: InnovAge PACE Commercial |
$622.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$870.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$870.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$622.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Riverside University Health System MISP |
$497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.87
|
| Rate for Payer: United Healthcare All Other HMO |
$454.43
|
| Rate for Payer: United Healthcare HMO Rider |
$444.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,057.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,057.40
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$539.55
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan 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: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| 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
|
|
|
HC KD ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
915355622
|
|
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 |
$409.94
|
| Rate for Payer: Blue Shield of California Commercial |
$539.55
|
| 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: 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: InnovAge PACE Commercial |
$349.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA 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 ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5622
|
| Hospital Charge Code |
905355622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Blue Shield of California Commercial |
$539.55
|
| Rate for Payer: Blue Shield of California EPN |
$351.79
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan 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: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| 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
|
|
|
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 |
$409.94
|
| Rate for Payer: Blue Shield of California Commercial |
$539.55
|
| 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: 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: InnovAge PACE Commercial |
$349.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$488.60
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$563.22
|
| Rate for Payer: Blue Shield of California Commercial |
$741.31
|
| 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: 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: InnovAge PACE Commercial |
$479.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$741.31
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| 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 |
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 |
$741.31
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| 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 |
915355656
|
|
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 |
$563.22
|
| Rate for Payer: Blue Shield of California Commercial |
$741.31
|
| 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: 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: InnovAge PACE Commercial |
$479.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$639.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$593.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$671.30
|
| Rate for Payer: Molina Healthcare of CA 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 SILICONE GEL
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT L5663
|
| Hospital Charge Code |
905355663
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.77 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$765.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,443.96
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,587.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,587.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: InnovAge PACE Commercial |
$934.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,307.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Riverside University Health System MISP |
$747.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,587.80
|
|
|
HC KD ADD SKT INSERT SILICONE GEL
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT L5663
|
| Hospital Charge Code |
905355663
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.60 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,443.96
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$1,214.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
|
|
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 |
$11,595.77
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| 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
|
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 |
$11,595.77
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,715.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| 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 |
$8,810.09
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.77
|
| 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: 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: InnovAge PACE Commercial |
$7,500.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.70
|
| Rate for Payer: Molina Healthcare of CA 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
|
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: 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 |
$8,810.09
|
| Rate for Payer: Blue Shield of California Commercial |
$11,595.77
|
| 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: 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: InnovAge PACE Commercial |
$7,500.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,005.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,599.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,150.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,500.70
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$5,744.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,560.71
|
| 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: 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: InnovAge PACE Commercial |
$4,890.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,010.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,846.70
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
