|
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 |
$684.20
|
| Rate for Payer: Cash Price |
$684.20
|
| 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
|
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 |
$684.20
|
| Rate for Payer: Cash Price |
$684.20
|
| 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 |
$684.20
|
| 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 |
$684.20
|
| 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 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 |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| 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 |
$383.90
|
| 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
|
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 |
$383.90
|
| 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 |
$383.90
|
| Rate for Payer: Cash Price |
$383.90
|
| 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 |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| 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 |
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 |
$527.45
|
| 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 |
$527.45
|
| Rate for Payer: Cash Price |
$527.45
|
| 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 |
$527.45
|
| 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 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 |
$1,027.40
|
| 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 |
$1,027.40
|
| 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
|
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 |
$8,250.55
|
| Rate for Payer: Cash Price |
$8,250.55
|
| 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
|
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 |
$8,250.55
|
| 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 |
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 |
$8,250.55
|
| Rate for Payer: Cash Price |
$8,250.55
|
| 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
|
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 |
$8,250.55
|
| 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 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 |
$5,379.55
|
| Rate for Payer: Cash Price |
$5,379.55
|
| 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
|
|
|
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 |
$5,744.38
|
| 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 |
$5,379.55
|
| Rate for Payer: Cash Price |
$5,379.55
|
| 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
|
|
|
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: Adventist Health Commercial |
$1,956.20
|
| 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 |
$5,379.55
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,726.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| 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 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 |
$7,560.71
|
| Rate for Payer: Blue Shield of California EPN |
$4,929.62
|
| Rate for Payer: Cash Price |
$5,379.55
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$6,523.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,726.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,054.44
|
| 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
|
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 |
$9,028.56
|
| Rate for Payer: Blue Shield of California Commercial |
$11,883.33
|
| Rate for Payer: Blue Shield of California EPN |
$7,747.99
|
| Rate for Payer: Cash Price |
$8,455.15
|
| 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: 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: InnovAge PACE Commercial |
$7,686.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,253.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,857.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,515.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,302.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,761.10
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$11,883.33
|
| Rate for Payer: Blue Shield of California EPN |
$7,747.99
|
| Rate for Payer: Cash Price |
$8,455.15
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$10,253.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,857.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,515.89
|
| 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 PROS MID SKT ENDO NO-COVER
|
Facility
|
IP
|
$6,320.00
|
|
|
Service Code
|
CPT L5311
|
| Hospital Charge Code |
905355311
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,264.00 |
| Max. Negotiated Rate |
$5,688.00 |
| Rate for Payer: Adventist Health Commercial |
$1,264.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,885.36
|
| Rate for Payer: Blue Shield of California EPN |
$3,185.28
|
| Rate for Payer: Cash Price |
$3,476.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,056.00
|
| Rate for Payer: Cigna of CA HMO |
$4,424.00
|
| Rate for Payer: Cigna of CA PPO |
$4,424.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,528.00
|
| Rate for Payer: Galaxy Health WC |
$5,372.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,688.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,407.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,912.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,264.00
|
| Rate for Payer: Multiplan Commercial |
$4,740.00
|
| Rate for Payer: Networks By Design Commercial |
$4,108.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.90
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2,258.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,069.80
|
|
