|
HC AK ADD EXOSK POLYCENTRIC FRICT
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT L5718
|
| Hospital Charge Code |
915355718
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$878.40 |
| Max. Negotiated Rate |
$3,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,013.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,745.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,215.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,814.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,855.62
|
| 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: Dignity Health Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,111.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,111.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,324.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.06
|
| 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: Molina Healthcare of CA Medi-Cal |
$2,562.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.00
|
| Rate for Payer: Multiplan Commercial |
$2,928.00
|
| Rate for Payer: Networks By Design Commercial |
$1,830.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,196.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,111.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,111.00
|
|
|
HC AK ADD EXOSK POLYCENTRIC FRICT
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT L5718
|
| Hospital Charge Code |
905355718
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$878.40 |
| Max. Negotiated Rate |
$3,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,500.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,013.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,745.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,215.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,814.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1,855.62
|
| 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: Dignity Health Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,111.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,111.00
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,324.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,065.06
|
| 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: Molina Healthcare of CA Medi-Cal |
$2,562.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.00
|
| Rate for Payer: Multiplan Commercial |
$2,928.00
|
| Rate for Payer: Networks By Design Commercial |
$1,830.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,196.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,111.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,111.00
|
|
|
HC AK ADD EXOSK POLYCENTRIC FRICT
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT L5718
|
| Hospital Charge Code |
915355718
|
|
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
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
905355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$426.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Multiplan Commercial |
$1,704.00
|
| Rate for Payer: Networks By Design Commercial |
$1,384.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
915355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$1,810.50 |
| Rate for Payer: Adventist Health Commercial |
$873.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,171.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,597.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,289.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,637.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.91
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,810.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,810.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$791.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$894.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,491.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,491.00
|
| Rate for Payer: Multiplan Commercial |
$1,704.00
|
| Rate for Payer: Networks By Design Commercial |
$1,065.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,278.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,810.50
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
905355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$511.20 |
| Max. Negotiated Rate |
$1,810.50 |
| Rate for Payer: Adventist Health Commercial |
$873.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,171.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,597.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,289.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,637.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.91
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,810.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,810.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$791.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$894.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,491.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,491.00
|
| Rate for Payer: Multiplan Commercial |
$1,704.00
|
| Rate for Payer: Networks By Design Commercial |
$1,065.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,278.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,810.50
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
915355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$426.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$511.20
|
| Rate for Payer: Multiplan Commercial |
$1,704.00
|
| Rate for Payer: Networks By Design Commercial |
$1,384.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
905355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$325.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.24
|
| Rate for Payer: Multiplan Commercial |
$1,300.80
|
| Rate for Payer: Networks By Design Commercial |
$1,056.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
915355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$325.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.24
|
| Rate for Payer: Multiplan Commercial |
$1,300.80
|
| Rate for Payer: Networks By Design Commercial |
$1,056.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
915355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$390.24 |
| Max. Negotiated Rate |
$1,382.10 |
| Rate for Payer: Adventist Health Commercial |
$666.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,219.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$984.22
|
| Rate for Payer: Blue Shield of California Commercial |
$824.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,250.39
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,382.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,382.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$843.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$954.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,138.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,138.20
|
| Rate for Payer: Multiplan Commercial |
$1,300.80
|
| Rate for Payer: Networks By Design Commercial |
$813.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,382.10
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
905355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$390.24 |
| Max. Negotiated Rate |
$1,382.10 |
| Rate for Payer: Adventist Health Commercial |
$666.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,219.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$984.22
|
| Rate for Payer: Blue Shield of California Commercial |
$824.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,250.39
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,382.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,382.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$843.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$954.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,138.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,138.20
|
| Rate for Payer: Multiplan Commercial |
$1,300.80
|
| Rate for Payer: Networks By Design Commercial |
$813.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,382.10
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
OP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
915355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,272.56 |
| Max. Negotiated Rate |
$8,048.65 |
| Rate for Payer: Adventist Health Commercial |
$3,882.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,207.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,101.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,731.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7,281.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,800.78
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,048.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,835.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,206.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,628.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,628.30
|
| Rate for Payer: Multiplan Commercial |
$7,575.20
|
| Rate for Payer: Networks By Design Commercial |
$4,734.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,681.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,681.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,048.65
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
IP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
915355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,893.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,893.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.56
|
| Rate for Payer: Multiplan Commercial |
$7,575.20
|
| Rate for Payer: Networks By Design Commercial |
$6,154.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
IP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
905355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,893.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,893.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.56
|
| Rate for Payer: Multiplan Commercial |
$7,575.20
|
| Rate for Payer: Networks By Design Commercial |
$6,154.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
OP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
905355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,272.56 |
| Max. Negotiated Rate |
$8,048.65 |
| Rate for Payer: Adventist Health Commercial |
$3,882.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,207.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,101.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,731.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7,281.66
|
| Rate for Payer: Blue Shield of California Commercial |
$4,800.78
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,048.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,835.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,206.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,628.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,628.30
|
| Rate for Payer: Multiplan Commercial |
$7,575.20
|
| Rate for Payer: Networks By Design Commercial |
$4,734.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,681.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,681.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,048.65
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
OP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
915355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$790.08 |
| Max. Negotiated Rate |
$2,798.20 |
| Rate for Payer: Adventist Health Commercial |
$1,349.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,810.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,469.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,531.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,669.04
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,798.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,798.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,393.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,575.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,304.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,304.40
|
| Rate for Payer: Multiplan Commercial |
$2,633.60
|
| Rate for Payer: Networks By Design Commercial |
$1,646.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,798.20
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
IP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
915355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$658.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.08
|
| Rate for Payer: Multiplan Commercial |
$2,633.60
|
| Rate for Payer: Networks By Design Commercial |
$2,139.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
OP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
905355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$790.08 |
| Max. Negotiated Rate |
$2,798.20 |
| Rate for Payer: Adventist Health Commercial |
$1,349.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,810.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,469.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,992.65
|
| Rate for Payer: Blue Shield of California Commercial |
$2,531.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,669.04
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,798.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,798.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,393.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,575.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,304.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,304.40
|
| Rate for Payer: Multiplan Commercial |
$2,633.60
|
| Rate for Payer: Networks By Design Commercial |
$1,646.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,798.20
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
IP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
905355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$658.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$658.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$790.08
|
| Rate for Payer: Multiplan Commercial |
$2,633.60
|
| Rate for Payer: Networks By Design Commercial |
$2,139.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$558.35
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
915355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$558.35
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.16 |
| Max. Negotiated Rate |
$730.15 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.95
|
| Rate for Payer: Blue Shield of California Commercial |
$660.57
|
| Rate for Payer: Blue Shield of California Commercial |
$435.51
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$323.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
915355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.16 |
| Max. Negotiated Rate |
$730.15 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.95
|
| Rate for Payer: Blue Shield of California Commercial |
$660.57
|
| Rate for Payer: Blue Shield of California Commercial |
$435.51
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$323.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$687.20
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
915355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$764.49
|
| Rate for Payer: Blue Shield of California Commercial |
$971.25
|
| Rate for Payer: Blue Shield of California Commercial |
$640.34
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$370.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$419.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$884.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
