|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
915355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$385.44 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$658.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$930.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.23
|
| Rate for Payer: Blue Shield of California EPN |
$780.52
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$522.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
905355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$385.44 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$658.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$930.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,185.23
|
| Rate for Payer: Blue Shield of California EPN |
$780.52
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$522.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
905355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
915355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
915355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$370.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.24
|
| Rate for Payer: Multiplan Commercial |
$1,480.80
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
915355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.24 |
| Max. Negotiated Rate |
$1,573.35 |
| Rate for Payer: Adventist Health Commercial |
$758.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,018.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,388.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,366.04
|
| Rate for Payer: Blue Shield of California EPN |
$899.59
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,573.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,573.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$533.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,295.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,295.70
|
| Rate for Payer: Multiplan Commercial |
$1,480.80
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,573.35
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
905355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$370.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.24
|
| Rate for Payer: Multiplan Commercial |
$1,480.80
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
905355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$444.24 |
| Max. Negotiated Rate |
$1,573.35 |
| Rate for Payer: Adventist Health Commercial |
$758.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,018.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,388.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,366.04
|
| Rate for Payer: Blue Shield of California EPN |
$899.59
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cash Price |
$832.95
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,573.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,573.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$533.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,295.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,295.70
|
| Rate for Payer: Multiplan Commercial |
$1,480.80
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,573.35
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
905355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.48 |
| Max. Negotiated Rate |
$894.20 |
| Rate for Payer: Adventist Health Commercial |
$431.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.32
|
| Rate for Payer: Blue Shield of California Commercial |
$776.38
|
| Rate for Payer: Blue Shield of California EPN |
$511.27
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$372.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$841.60
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
905355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.48
|
| Rate for Payer: Multiplan Commercial |
$841.60
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
915355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.48 |
| Max. Negotiated Rate |
$894.20 |
| Rate for Payer: Adventist Health Commercial |
$431.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.32
|
| Rate for Payer: Blue Shield of California Commercial |
$776.38
|
| Rate for Payer: Blue Shield of California EPN |
$511.27
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$372.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$841.60
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
915355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.48
|
| Rate for Payer: Multiplan Commercial |
$841.60
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
905355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$1,319.20 |
| Rate for Payer: Adventist Health Commercial |
$636.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,164.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$898.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.38
|
| Rate for Payer: Blue Shield of California EPN |
$754.27
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,319.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$717.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$811.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,086.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,086.40
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,319.20
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
915355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$1,319.20 |
| Rate for Payer: Adventist Health Commercial |
$636.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,164.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$898.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.38
|
| Rate for Payer: Blue Shield of California EPN |
$754.27
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,319.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$717.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$811.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,086.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,086.40
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,319.20
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
905355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$310.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.48
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
915355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$310.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.48
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
905355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$833.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.04
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
915355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$833.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.04
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
915355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$323.04 |
| Max. Negotiated Rate |
$1,144.10 |
| Rate for Payer: Adventist Health Commercial |
$551.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$740.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.60
|
| Rate for Payer: Blue Shield of California Commercial |
$993.35
|
| Rate for Payer: Blue Shield of California EPN |
$654.16
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,144.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,144.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$585.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$662.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$833.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$942.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$942.20
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.10
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
905355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$323.04 |
| Max. Negotiated Rate |
$1,144.10 |
| Rate for Payer: Adventist Health Commercial |
$551.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$740.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,009.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.60
|
| Rate for Payer: Blue Shield of California Commercial |
$993.35
|
| Rate for Payer: Blue Shield of California EPN |
$654.16
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,144.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,144.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$585.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$662.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$833.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$942.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$942.20
|
| Rate for Payer: Multiplan Commercial |
$1,076.80
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.10
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
915355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.18
|
| Rate for Payer: Blue Shield of California Commercial |
$383.76
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
915355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
905355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.18
|
| Rate for Payer: Blue Shield of California Commercial |
$383.76
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5629
|
| Hospital Charge Code |
905355629
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC BK ADDITION AIR CUSSION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5646
|
| Hospital Charge Code |
915355646
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$781.80
|
| 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 |
$631.50
|
| 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
|
|
