|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
915355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
905355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.92 |
| Max. Negotiated Rate |
$538.05 |
| Rate for Payer: Adventist Health Commercial |
$259.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.15
|
| Rate for Payer: Blue Shield of California Commercial |
$486.78
|
| Rate for Payer: Blue Shield of California Commercial |
$320.93
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.10
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$316.50
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.05
|
| Rate for Payer: Vantage Medical Group Senior |
$538.05
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
905355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
915355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$151.92 |
| Max. Negotiated Rate |
$538.05 |
| Rate for Payer: Adventist Health Commercial |
$259.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.15
|
| Rate for Payer: Blue Shield of California Commercial |
$486.78
|
| Rate for Payer: Blue Shield of California Commercial |
$320.93
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$286.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.10
|
| Rate for Payer: Multiplan Commercial |
$506.40
|
| Rate for Payer: Networks By Design Commercial |
$316.50
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.05
|
| Rate for Payer: Vantage Medical Group Senior |
$538.05
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
OP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
905355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,621.20 |
| Max. Negotiated Rate |
$5,741.75 |
| Rate for Payer: Adventist Health Commercial |
$2,769.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,715.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,066.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,088.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,194.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,424.78
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,741.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,741.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,728.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,125.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,289.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,404.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,985.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,728.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,728.50
|
| Rate for Payer: Multiplan Commercial |
$5,404.00
|
| Rate for Payer: Networks By Design Commercial |
$3,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,741.75
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
OP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
915355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,621.20 |
| Max. Negotiated Rate |
$5,741.75 |
| Rate for Payer: Adventist Health Commercial |
$2,769.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,715.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,066.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,088.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,194.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,424.78
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,741.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,741.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,728.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,125.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,289.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,404.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,985.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,728.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,728.50
|
| Rate for Payer: Multiplan Commercial |
$5,404.00
|
| Rate for Payer: Networks By Design Commercial |
$3,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,741.75
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
IP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
905355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,351.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,351.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,728.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,289.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,985.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$5,404.00
|
| Rate for Payer: Networks By Design Commercial |
$4,390.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
IP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
915355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,351.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,351.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,728.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,289.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,985.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$5,404.00
|
| Rate for Payer: Networks By Design Commercial |
$4,390.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
905355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,220.02 |
| Max. Negotiated Rate |
$5,264.90 |
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: Adventist Health Commercial |
$2,539.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,406.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,749.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,763.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,140.36
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,264.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,264.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,220.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,933.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,379.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,654.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,335.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,335.80
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Networks By Design Commercial |
$3,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,716.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,716.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,264.90
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
915355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,238.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,238.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,933.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,654.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.56
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Networks By Design Commercial |
$4,026.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
915355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,220.02 |
| Max. Negotiated Rate |
$5,264.90 |
| Rate for Payer: Adventist Health Commercial |
$2,539.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,406.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,749.23
|
| Rate for Payer: Blue Shield of California Commercial |
$4,763.19
|
| Rate for Payer: Blue Shield of California Commercial |
$3,140.36
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,264.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,264.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,220.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,933.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,379.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,654.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,335.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,335.80
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Networks By Design Commercial |
$3,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,716.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,716.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,264.90
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
905355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,238.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,238.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,933.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,654.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,486.56
|
| Rate for Payer: Multiplan Commercial |
$4,955.20
|
| Rate for Payer: Networks By Design Commercial |
$4,026.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
905355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$2,028.95 |
| Rate for Payer: Adventist Health Commercial |
$978.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,312.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,790.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,444.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,835.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,210.21
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,028.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,028.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,670.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$873.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,515.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$988.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,670.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,670.90
|
| Rate for Payer: Multiplan Commercial |
$1,909.60
|
| Rate for Payer: Networks By Design Commercial |
$1,193.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,432.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,028.95
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
915355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$2,028.95 |
| Rate for Payer: Adventist Health Commercial |
$978.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,312.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,790.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,444.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,835.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,210.21
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,028.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,028.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,670.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$873.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,515.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$988.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,670.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,670.90
|
| Rate for Payer: Multiplan Commercial |
$1,909.60
|
| Rate for Payer: Networks By Design Commercial |
$1,193.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,432.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,028.95
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
915355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$477.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,670.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,515.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.88
|
| Rate for Payer: Multiplan Commercial |
$1,909.60
|
| Rate for Payer: Networks By Design Commercial |
$1,551.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
905355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$477.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,670.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,515.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,408.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.88
|
| Rate for Payer: Multiplan Commercial |
$1,909.60
|
| Rate for Payer: Networks By Design Commercial |
$1,551.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
OP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
905355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$580.41 |
| Max. Negotiated Rate |
$3,654.15 |
| Rate for Payer: Adventist Health Commercial |
$1,762.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,364.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,224.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,602.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,305.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2,179.59
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,654.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,654.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,009.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$580.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,729.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,536.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,009.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,009.30
|
| Rate for Payer: Multiplan Commercial |
$3,439.20
|
| Rate for Payer: Networks By Design Commercial |
$2,149.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,579.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,579.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,613.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,536.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,407.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,654.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,654.15
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
IP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
905355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$859.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$859.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,009.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,729.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,536.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.76
|
| Rate for Payer: Multiplan Commercial |
$3,439.20
|
| Rate for Payer: Networks By Design Commercial |
$2,794.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,613.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,536.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,407.92
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
IP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
915355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$859.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$859.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,009.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,729.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,536.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.76
|
| Rate for Payer: Multiplan Commercial |
$3,439.20
|
| Rate for Payer: Networks By Design Commercial |
$2,794.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,613.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,536.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,407.92
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
OP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
915355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$580.41 |
| Max. Negotiated Rate |
$3,654.15 |
| Rate for Payer: Adventist Health Commercial |
$1,762.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,364.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,224.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,602.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,305.93
|
| Rate for Payer: Blue Shield of California Commercial |
$2,179.59
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,654.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,654.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,009.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$580.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,729.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$656.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,536.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,031.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,009.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,009.30
|
| Rate for Payer: Multiplan Commercial |
$3,439.20
|
| Rate for Payer: Networks By Design Commercial |
$2,149.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,579.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,579.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,613.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,536.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,407.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,654.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,654.15
|
|
|
HC AK ADD EXOSK PNEUMATIC SWING
|
Facility
|
OP
|
$3,003.00
|
|
|
Service Code
|
CPT L5722
|
| Hospital Charge Code |
915355722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$720.72 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Adventist Health Commercial |
$1,231.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,651.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,252.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,817.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.52
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cigna of CA HMO |
$2,102.10
|
| Rate for Payer: Cigna of CA PPO |
$2,102.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,552.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,552.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,102.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,169.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,906.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,322.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,771.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.10
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,501.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,073.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$983.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,552.55
|
|
|
HC AK ADD EXOSK PNEUMATIC SWING
|
Facility
|
OP
|
$3,003.00
|
|
|
Service Code
|
CPT L5722
|
| Hospital Charge Code |
905355722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$720.72 |
| Max. Negotiated Rate |
$2,552.55 |
| Rate for Payer: Adventist Health Commercial |
$1,231.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,651.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,252.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,817.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,309.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,522.52
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cigna of CA HMO |
$2,102.10
|
| Rate for Payer: Cigna of CA PPO |
$2,102.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,552.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,552.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,102.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,169.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,906.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,322.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,771.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.10
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,501.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,073.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$983.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,552.55
|
|
|
HC AK ADD EXOSK PNEUMATIC SWING
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT L5722
|
| Hospital Charge Code |
915355722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cigna of CA HMO |
$2,102.10
|
| Rate for Payer: Cigna of CA PPO |
$2,102.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,102.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,906.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,771.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,073.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$983.48
|
|
|
HC AK ADD EXOSK PNEUMATIC SWING
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT L5722
|
| Hospital Charge Code |
905355722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cigna of CA HMO |
$2,102.10
|
| Rate for Payer: Cigna of CA PPO |
$2,102.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,102.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,906.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,771.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$720.72
|
| Rate for Payer: Multiplan Commercial |
$2,402.40
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,127.03
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,073.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$983.48
|
|
|
HC AK ADD EXOSK POLYCENTRIC FRICT
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT L5718
|
| Hospital Charge Code |
905355718
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$732.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$732.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cigna of CA HMO |
$2,562.00
|
| Rate for Payer: Cigna of CA PPO |
$2,562.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,562.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,464.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,464.00
|
| Rate for Payer: Galaxy Health WC |
$3,111.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,324.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,159.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.40
|
| Rate for Payer: Multiplan Commercial |
$2,928.00
|
| Rate for Payer: Networks By Design Commercial |
$2,379.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,373.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,337.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,308.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,198.65
|
|
