|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
IP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$738.90 |
| Rate for Payer: Blue Shield of California EPN |
$438.41
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Central Health Plan Commercial |
$656.80
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.20
|
| Rate for Payer: Multiplan Commercial |
$615.75
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
IP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Blue Shield of California EPN |
$397.83
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
OP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$260.75 |
| Max. Negotiated Rate |
$2,108.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,108.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$409.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$440.15
|
| Rate for Payer: BCBS Transplant Transplant |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$558.75
|
| Rate for Payer: Blue Shield of California EPN |
$405.28
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$558.75
|
| Rate for Payer: IEHP medi-cal |
$260.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.45
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Riverside University Health MISP |
$298.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.50
|
| Rate for Payer: United Healthcare All Other HMO |
$372.50
|
| Rate for Payer: United Healthcare HMO Rider |
$372.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
IP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
905355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,910.20 |
| Max. Negotiated Rate |
$17,595.90 |
| Rate for Payer: Blue Shield of California EPN |
$10,440.23
|
| Rate for Payer: Cash Price |
$8,797.95
|
| Rate for Payer: Central Health Plan Commercial |
$15,640.80
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,595.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,910.20
|
| Rate for Payer: Multiplan Commercial |
$14,663.25
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
|
|
HC HD CANDIAN TYPE W/SACH FOOT
|
Facility
OP
|
$19,551.00
|
|
|
Service Code
|
CPT L5250
|
| Hospital Charge Code |
905355250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,842.85 |
| Max. Negotiated Rate |
$22,949.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,949.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$16,618.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,753.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,753.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,466.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,550.73
|
| Rate for Payer: BCBS Transplant Transplant |
$11,730.60
|
| Rate for Payer: Blue Shield of California Commercial |
$14,663.25
|
| Rate for Payer: Blue Shield of California EPN |
$10,635.74
|
| Rate for Payer: Cash Price |
$8,797.95
|
| Rate for Payer: Cash Price |
$8,797.95
|
| Rate for Payer: Central Health Plan Commercial |
$15,640.80
|
| Rate for Payer: Cigna of CA HMO |
$13,685.70
|
| Rate for Payer: Cigna of CA PPO |
$13,685.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,618.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,820.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,820.40
|
| Rate for Payer: Galaxy Health WC |
$16,618.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,730.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,595.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14,663.25
|
| Rate for Payer: IEHP medi-cal |
$6,842.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,040.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,015.91
|
| Rate for Payer: Multiplan Commercial |
$14,663.25
|
| Rate for Payer: Networks By Design Commercial |
$9,775.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,618.35
|
| Rate for Payer: Riverside University Health MISP |
$7,820.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,730.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,730.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,775.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,775.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,775.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,775.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,618.35
|
| Rate for Payer: Vantage Medical Group Senior |
$16,618.35
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
IP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
905355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,748.80 |
| Max. Negotiated Rate |
$7,869.60 |
| Rate for Payer: Blue Shield of California EPN |
$4,669.30
|
| Rate for Payer: Cash Price |
$3,934.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,995.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,869.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,748.80
|
| Rate for Payer: Multiplan Commercial |
$6,558.00
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
|
|
HC HD/HP PREP LAMINATED SOCKET
|
Facility
OP
|
$8,744.00
|
|
|
Service Code
|
CPT L5600
|
| Hospital Charge Code |
905355600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,060.40 |
| Max. Negotiated Rate |
$19,666.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,666.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,432.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,809.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,809.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,233.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,165.96
|
| Rate for Payer: BCBS Transplant Transplant |
$5,246.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,558.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,756.74
|
| Rate for Payer: Cash Price |
$3,934.80
|
| Rate for Payer: Cash Price |
$3,934.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,995.20
|
| Rate for Payer: Cigna of CA HMO |
$6,120.80
|
| Rate for Payer: Cigna of CA PPO |
$6,120.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,432.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,497.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,497.60
|
| Rate for Payer: Galaxy Health WC |
$7,432.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,246.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,869.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,558.00
|
| Rate for Payer: IEHP medi-cal |
$3,060.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,832.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,585.04
|
| Rate for Payer: Multiplan Commercial |
$6,558.00
|
| Rate for Payer: Networks By Design Commercial |
$4,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,432.40
|
| Rate for Payer: Riverside University Health MISP |
$3,497.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,372.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,372.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,372.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,372.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,432.40
|
| Rate for Payer: Vantage Medical Group Senior |
$7,432.40
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
OP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,622.90 |
| Max. Negotiated Rate |
$17,809.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17,809.36
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,369.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,121.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,121.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,628.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,427.46
|
| Rate for Payer: BCBS Transplant Transplant |
$4,496.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,620.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,076.74
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,995.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,369.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,744.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,620.50
|
| Rate for Payer: IEHP medi-cal |
$2,622.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,072.54
|
| Rate for Payer: Multiplan Commercial |
$5,620.50
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
| Rate for Payer: Riverside University Health MISP |
$2,997.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,496.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,496.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,747.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,747.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,747.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,747.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,369.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,369.90
|
|
|
HC HD/HP PREP THERMOPLASTIC SACH
|
Facility
IP
|
$7,494.00
|
|
|
Service Code
|
CPT L5595
|
| Hospital Charge Code |
905355595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,498.80 |
| Max. Negotiated Rate |
$6,744.60 |
| Rate for Payer: Blue Shield of California EPN |
$4,001.80
|
| Rate for Payer: Cash Price |
$3,372.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,995.20
|
| Rate for Payer: Cigna of CA HMO |
$5,245.80
|
| Rate for Payer: Cigna of CA PPO |
$5,245.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,997.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,997.60
|
| Rate for Payer: Galaxy Health WC |
$6,369.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,496.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,744.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,998.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,498.80
|
| Rate for Payer: Multiplan Commercial |
$5,620.50
|
| Rate for Payer: Networks By Design Commercial |
$3,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,369.90
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
IP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,423.00 |
| Max. Negotiated Rate |
$6,403.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,799.41
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,692.00
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,403.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,336.25
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
|
|
HC HD LOW LIMB PROS VACUUM PUMP
|
Facility
OP
|
$7,115.00
|
|
|
Service Code
|
CPT L5782
|
| Hospital Charge Code |
905355782
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,490.25 |
| Max. Negotiated Rate |
$16,763.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,763.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,047.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,913.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,913.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,445.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,203.54
|
| Rate for Payer: BCBS Transplant Transplant |
$4,269.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,336.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,870.56
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Cash Price |
$3,201.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,692.00
|
| Rate for Payer: Cigna of CA HMO |
$4,980.50
|
| Rate for Payer: Cigna of CA PPO |
$4,980.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,047.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,846.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,846.00
|
| Rate for Payer: Galaxy Health WC |
$6,047.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,403.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,336.25
|
| Rate for Payer: IEHP medi-cal |
$2,490.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,917.15
|
| Rate for Payer: Multiplan Commercial |
$5,336.25
|
| Rate for Payer: Networks By Design Commercial |
$3,557.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,047.75
|
| Rate for Payer: Riverside University Health MISP |
$2,846.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,557.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,557.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,557.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,557.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,047.75
|
| Rate for Payer: Vantage Medical Group Senior |
$6,047.75
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
OP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,269.35 |
| Max. Negotiated Rate |
$20,570.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,570.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,939.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,137.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5,137.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,522.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,518.66
|
| Rate for Payer: BCBS Transplant Transplant |
$5,604.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,005.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,081.50
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,939.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,005.75
|
| Rate for Payer: IEHP medi-cal |
$3,269.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,829.81
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
| Rate for Payer: Riverside University Health MISP |
$3,736.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,604.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,604.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,670.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,670.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,670.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,670.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,939.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,939.85
|
|
|
HC HD PROS MID SKT ENDO,NO-COVER
|
Facility
IP
|
$9,341.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
905355331
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.20 |
| Max. Negotiated Rate |
$8,406.90 |
| Rate for Payer: Blue Shield of California EPN |
$4,988.09
|
| Rate for Payer: Cash Price |
$4,203.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,472.80
|
| Rate for Payer: Cigna of CA HMO |
$6,538.70
|
| Rate for Payer: Cigna of CA PPO |
$6,538.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,736.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,736.40
|
| Rate for Payer: Galaxy Health WC |
$7,939.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,604.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,406.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,230.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,868.20
|
| Rate for Payer: Multiplan Commercial |
$7,005.75
|
| Rate for Payer: Networks By Design Commercial |
$4,670.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,939.85
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
IP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$1,627.20 |
| Rate for Payer: Blue Shield of California EPN |
$965.47
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.60
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SHAPED COVER
|
Facility
OP
|
$1,808.00
|
|
|
Service Code
|
CPT L5707
|
| Hospital Charge Code |
905355707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$5,471.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,471.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,536.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$994.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$994.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$875.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,068.17
|
| Rate for Payer: BCBS Transplant Transplant |
$1,084.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,356.00
|
| Rate for Payer: Blue Shield of California EPN |
$983.55
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,446.40
|
| Rate for Payer: Cigna of CA HMO |
$1,265.60
|
| Rate for Payer: Cigna of CA PPO |
$1,265.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,536.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$723.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$723.20
|
| Rate for Payer: Galaxy Health WC |
$1,536.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,084.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,627.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,356.00
|
| Rate for Payer: IEHP medi-cal |
$632.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,205.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$741.28
|
| Rate for Payer: Multiplan Commercial |
$1,356.00
|
| Rate for Payer: Networks By Design Commercial |
$904.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,536.80
|
| Rate for Payer: Riverside University Health MISP |
$723.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,084.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,084.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$904.00
|
| Rate for Payer: United Healthcare All Other HMO |
$904.00
|
| Rate for Payer: United Healthcare HMO Rider |
$904.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$904.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,536.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,536.80
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
IP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,760.20 |
| Max. Negotiated Rate |
$7,920.90 |
| Rate for Payer: Blue Shield of California EPN |
$4,699.73
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,760.20
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
|
|
HC HD REPLACEMENT OF SOCKET
|
Facility
OP
|
$8,801.00
|
|
|
Service Code
|
CPT L5702
|
| Hospital Charge Code |
905355702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,080.35 |
| Max. Negotiated Rate |
$19,216.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19,216.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,480.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,840.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,840.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,261.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,199.63
|
| Rate for Payer: BCBS Transplant Transplant |
$5,280.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,600.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,787.74
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Cash Price |
$3,960.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,040.80
|
| Rate for Payer: Cigna of CA HMO |
$6,160.70
|
| Rate for Payer: Cigna of CA PPO |
$6,160.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,480.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,520.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,520.40
|
| Rate for Payer: Galaxy Health WC |
$7,480.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,280.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,920.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,600.75
|
| Rate for Payer: IEHP medi-cal |
$3,080.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,870.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,608.41
|
| Rate for Payer: Multiplan Commercial |
$6,600.75
|
| Rate for Payer: Networks By Design Commercial |
$4,400.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,480.85
|
| Rate for Payer: Riverside University Health MISP |
$3,520.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,280.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,280.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,400.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,400.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,400.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,400.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,480.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,480.85
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
IP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,723.40 |
| Max. Negotiated Rate |
$16,755.30 |
| Rate for Payer: Blue Shield of California EPN |
$9,941.48
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,723.40
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
|
|
HC HD TILT TABLE WITH SACH
|
Facility
OP
|
$18,617.00
|
|
|
Service Code
|
CPT L5270
|
| Hospital Charge Code |
905355270
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,515.95 |
| Max. Negotiated Rate |
$22,748.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22,748.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,824.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$10,239.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10,239.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,014.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,998.92
|
| Rate for Payer: BCBS Transplant Transplant |
$11,170.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13,962.75
|
| Rate for Payer: Blue Shield of California EPN |
$10,127.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Cash Price |
$8,377.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,893.60
|
| Rate for Payer: Cigna of CA HMO |
$13,031.90
|
| Rate for Payer: Cigna of CA PPO |
$13,031.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,824.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,446.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,446.80
|
| Rate for Payer: Galaxy Health WC |
$15,824.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11,170.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,755.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,962.75
|
| Rate for Payer: IEHP medi-cal |
$6,515.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,417.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,632.97
|
| Rate for Payer: Multiplan Commercial |
$13,962.75
|
| Rate for Payer: Networks By Design Commercial |
$9,308.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,824.45
|
| Rate for Payer: Riverside University Health MISP |
$7,446.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,170.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,170.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,308.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,308.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,308.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,308.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,824.45
|
| Rate for Payer: Vantage Medical Group Senior |
$15,824.45
|
|
|
HC HEAD ECHO
|
Facility
OP
|
$1,703.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$16,107.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.53
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,006.13
|
| Rate for Payer: BCBS Transplant Transplant |
$1,021.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,052.45
|
| Rate for Payer: Blue Shield of California EPN |
$827.66
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: Cigna of CA HMO |
$1,089.92
|
| Rate for Payer: Cigna of CA PPO |
$1,260.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,277.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,021.80
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,021.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,021.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,107.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC HEAD ECHO
|
Facility
IP
|
$1,703.00
|
|
|
Service Code
|
CPT 76506
|
| Hospital Charge Code |
906601400
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$1,532.70 |
| Rate for Payer: Cash Price |
$766.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.20
|
| Rate for Payer: Galaxy Health WC |
$1,447.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,021.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,532.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,135.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.60
|
| Rate for Payer: Multiplan Commercial |
$1,277.25
|
| Rate for Payer: Networks By Design Commercial |
$1,106.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,447.55
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Blue Shield of California EPN |
$80.10
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC HEEL COUNTER LEATHER
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT L3440
|
| Hospital Charge Code |
905353440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$302.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$302.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.62
|
| Rate for Payer: BCBS Transplant Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$112.50
|
| Rate for Payer: Blue Shield of California EPN |
$81.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.50
|
| Rate for Payer: IEHP medi-cal |
$52.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Blue Shield of California EPN |
$134.57
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
|
|
HC HEEL COUNTER PLASTIC
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT L3430
|
| Hospital Charge Code |
905353430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$635.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$635.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$138.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.88
|
| Rate for Payer: BCBS Transplant Transplant |
$151.20
|
| Rate for Payer: Blue Shield of California Commercial |
$189.00
|
| Rate for Payer: Blue Shield of California EPN |
$137.09
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$176.40
|
| Rate for Payer: Cigna of CA PPO |
$176.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$189.00
|
| Rate for Payer: IEHP medi-cal |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.32
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$126.00
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Riverside University Health MISP |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.00
|
| Rate for Payer: United Healthcare All Other HMO |
$126.00
|
| Rate for Payer: United Healthcare HMO Rider |
$126.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
