|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
IP
|
$4,595.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$919.00 |
| Max. Negotiated Rate |
$3,905.75 |
| Rate for Payer: Adventist Health Commercial |
$919.00
|
| Rate for Payer: Cash Price |
$2,067.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,838.00
|
| Rate for Payer: Galaxy Health WC |
$3,905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,757.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,064.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,750.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,844.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.80
|
| Rate for Payer: Multiplan Commercial |
$3,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,986.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,905.75
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
IP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
915355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$924.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,083.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,761.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,861.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.52
|
| Rate for Payer: Multiplan Commercial |
$3,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,311.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.03
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
OP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
915355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,109.52 |
| Max. Negotiated Rate |
$3,929.55 |
| Rate for Payer: Adventist Health Commercial |
$1,895.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,542.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,467.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,677.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3,411.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,246.78
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,929.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,929.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,136.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,083.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,861.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,236.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,236.10
|
| Rate for Payer: Multiplan Commercial |
$3,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,311.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,773.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,773.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,929.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,929.55
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
OP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
905355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,109.52 |
| Max. Negotiated Rate |
$3,929.55 |
| Rate for Payer: Adventist Health Commercial |
$1,895.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,542.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,467.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,677.64
|
| Rate for Payer: Blue Shield of California Commercial |
$3,411.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,246.78
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,929.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,929.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,136.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,083.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,861.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,236.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,236.10
|
| Rate for Payer: Multiplan Commercial |
$3,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,311.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,773.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,773.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,929.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,929.55
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
IP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
905355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$924.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,083.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,761.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,861.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.52
|
| Rate for Payer: Multiplan Commercial |
$3,698.40
|
| Rate for Payer: Networks By Design Commercial |
$2,311.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.01
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.78
|
| Rate for Payer: United Healthcare HMO Rider |
$1,652.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,514.03
|
|
|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
IP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
905355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,810.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,810.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,449.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,604.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,172.96
|
| Rate for Payer: Multiplan Commercial |
$7,243.20
|
| Rate for Payer: Networks By Design Commercial |
$4,527.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,397.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,965.18
|
|
|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
IP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
915355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,810.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,810.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,449.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,604.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,172.96
|
| Rate for Payer: Multiplan Commercial |
$7,243.20
|
| Rate for Payer: Networks By Design Commercial |
$4,527.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,397.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,965.18
|
|
|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
OP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
915355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,448.83 |
| Max. Negotiated Rate |
$7,695.90 |
| Rate for Payer: Adventist Health Commercial |
$3,712.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,979.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,790.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,244.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,681.85
|
| Rate for Payer: Blue Shield of California EPN |
$4,400.24
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,695.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,695.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,448.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,638.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,604.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,172.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,337.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,337.80
|
| Rate for Payer: Multiplan Commercial |
$7,243.20
|
| Rate for Payer: Networks By Design Commercial |
$4,527.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,432.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,432.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,397.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,965.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,695.90
|
| Rate for Payer: Vantage Medical Group Senior |
$7,695.90
|
|
|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
OP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
905355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,448.83 |
| Max. Negotiated Rate |
$7,695.90 |
| Rate for Payer: Adventist Health Commercial |
$3,712.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,979.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,790.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,244.08
|
| Rate for Payer: Blue Shield of California Commercial |
$6,681.85
|
| Rate for Payer: Blue Shield of California EPN |
$4,400.24
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,695.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,695.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,448.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,638.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,604.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,172.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,337.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,337.80
|
| Rate for Payer: Multiplan Commercial |
$7,243.20
|
| Rate for Payer: Networks By Design Commercial |
$4,527.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,432.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,432.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,397.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,965.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,695.90
|
| Rate for Payer: Vantage Medical Group Senior |
$7,695.90
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
OP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
905355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,785.52 |
| Max. Negotiated Rate |
$11,197.90 |
| Rate for Payer: Adventist Health Commercial |
$5,401.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,245.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,630.38
|
| Rate for Payer: Blue Shield of California Commercial |
$9,722.41
|
| Rate for Payer: Blue Shield of California EPN |
$6,402.56
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,197.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,197.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,785.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,019.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,221.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,221.80
|
| Rate for Payer: Multiplan Commercial |
$10,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,904.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,904.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11,197.90
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
IP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
905355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,634.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,634.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,019.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.76
|
| Rate for Payer: Multiplan Commercial |
$10,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
OP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
915355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,785.52 |
| Max. Negotiated Rate |
$11,197.90 |
| Rate for Payer: Adventist Health Commercial |
$5,401.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,245.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,630.38
|
| Rate for Payer: Blue Shield of California Commercial |
$9,722.41
|
| Rate for Payer: Blue Shield of California EPN |
$6,402.56
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,197.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,197.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,785.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,019.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,221.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,221.80
|
| Rate for Payer: Multiplan Commercial |
$10,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,904.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,904.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11,197.90
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
IP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
915355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,634.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,634.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,019.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,161.76
|
| Rate for Payer: Multiplan Commercial |
$10,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
905355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$590.88 |
| Max. Negotiated Rate |
$2,092.70 |
| Rate for Payer: Adventist Health Commercial |
$1,009.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,354.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,425.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,816.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.53
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,092.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,092.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$762.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,642.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,523.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,723.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,723.40
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,477.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,477.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,092.70
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
905355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$492.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,642.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$938.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,523.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.88
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
915355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$492.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,642.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$938.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,523.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.88
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
915355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$590.88 |
| Max. Negotiated Rate |
$2,092.70 |
| Rate for Payer: Adventist Health Commercial |
$1,009.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,354.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,425.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,816.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,196.53
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,092.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,092.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$762.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,642.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,523.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$590.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,723.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,723.40
|
| Rate for Payer: Multiplan Commercial |
$1,969.60
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,477.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,477.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,092.70
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
905355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,086.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.44
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
915355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$1,492.60 |
| Rate for Payer: Adventist Health Commercial |
$719.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,317.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,017.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,295.93
|
| Rate for Payer: Blue Shield of California EPN |
$853.42
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,492.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,492.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$485.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,086.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,229.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,229.20
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,053.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,492.60
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
915355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,086.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.44
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
905355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$421.44 |
| Max. Negotiated Rate |
$1,492.60 |
| Rate for Payer: Adventist Health Commercial |
$719.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,317.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,017.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,295.93
|
| Rate for Payer: Blue Shield of California EPN |
$853.42
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,492.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,492.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$485.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,086.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,229.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,229.20
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,053.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,492.60
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
915355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$702.19 |
| Max. Negotiated Rate |
$4,487.15 |
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Adventist Health Commercial |
$2,164.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,903.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,959.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,057.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,895.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,565.59
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,487.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,487.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$702.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,695.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,695.30
|
| Rate for Payer: Multiplan Commercial |
$4,223.20
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,167.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,487.15
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
905355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,055.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,055.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,011.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.96
|
| Rate for Payer: Multiplan Commercial |
$4,223.20
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
915355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,055.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,055.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,011.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.96
|
| Rate for Payer: Multiplan Commercial |
$4,223.20
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
905355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$702.19 |
| Max. Negotiated Rate |
$4,487.15 |
| Rate for Payer: Adventist Health Commercial |
$2,164.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,903.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,959.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,057.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,895.90
|
| Rate for Payer: Blue Shield of California EPN |
$2,565.59
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,487.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,487.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$702.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,266.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,695.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,695.30
|
| Rate for Payer: Multiplan Commercial |
$4,223.20
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,167.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,487.15
|
|
