|
HC HBO THERAPY SUB 15 MIN INCREM
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
900803111
|
|
Hospital Revenue Code
|
413
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$579.70 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.68
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC HCV RNA QUANT
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$430.17
|
| Rate for Payer: Blue Shield of California EPN |
$284.21
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913610
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.55
|
| Rate for Payer: Blue Shield of California Commercial |
$107.04
|
| Rate for Payer: Blue Shield of California EPN |
$70.72
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$102.40
|
| Rate for Payer: Cigna of CA PPO |
$118.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$96.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$96.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC HCV RNA QUANT PCR TEST
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
900913694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$136.00 |
| Rate for Payer: Adventist Health Commercial |
$32.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.00
|
| Rate for Payer: EPIC Health Plan Senior |
$64.00
|
| Rate for Payer: Galaxy Health WC |
$136.00
|
| Rate for Payer: Global Benefits Group Commercial |
$96.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$99.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Networks By Design Commercial |
$104.00
|
| Rate for Payer: Prime Health Services Commercial |
$136.00
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
905355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$766.32 |
| Max. Negotiated Rate |
$2,714.05 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,849.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,551.80
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$944.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$766.32 |
| Max. Negotiated Rate |
$2,714.05 |
| Rate for Payer: Adventist Health Commercial |
$1,309.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,756.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,394.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,849.39
|
| Rate for Payer: Blue Shield of California Commercial |
$2,356.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,551.80
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,714.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$944.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,235.10
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,915.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,714.05
|
|
|
HC HD ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$3,193.00
|
|
|
Service Code
|
CPT L5960
|
| Hospital Charge Code |
915355960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$638.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cash Price |
$1,756.15
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,277.20
|
| Rate for Payer: Galaxy Health WC |
$2,714.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,976.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.32
|
| Rate for Payer: Multiplan Commercial |
$2,554.40
|
| Rate for Payer: Networks By Design Commercial |
$1,596.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,714.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,198.33
|
| Rate for Payer: United Healthcare All Other HMO |
$1,166.40
|
| Rate for Payer: United Healthcare HMO Rider |
$1,141.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,045.71
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$897.44 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$2,215.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,971.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,052.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,129.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,987.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,625.86
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,592.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,592.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$897.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,782.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,782.10
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,592.55
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
915355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$897.44 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$2,215.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,971.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,052.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,129.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3,987.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,625.86
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,592.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,592.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$897.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,782.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,782.10
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,592.55
|
| Rate for Payer: Vantage Medical Group Senior |
$4,592.55
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
915355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
|
|
HC HD ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT L5795
|
| Hospital Charge Code |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,701.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,027.75
|
| Rate for Payer: United Healthcare All Other HMO |
$1,973.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,931.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,769.48
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.28 |
| Max. Negotiated Rate |
$2,164.95 |
| Rate for Payer: Adventist Health Commercial |
$1,044.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,910.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,879.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,237.84
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,164.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,159.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,782.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,782.90
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
OP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
915355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.28 |
| Max. Negotiated Rate |
$2,164.95 |
| Rate for Payer: Adventist Health Commercial |
$1,044.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,400.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,910.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,879.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,237.84
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,164.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,164.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,159.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,782.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,782.90
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,528.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,164.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,164.95
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
915355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
|
|
HC HD ADD FLEX INNER SKT EXTR FRM
|
Facility
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cash Price |
$1,400.85
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,018.80
|
| Rate for Payer: Galaxy Health WC |
$2,164.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,698.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$970.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,576.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.28
|
| Rate for Payer: Multiplan Commercial |
$2,037.60
|
| Rate for Payer: Networks By Design Commercial |
$1,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,164.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$955.89
|
| Rate for Payer: United Healthcare All Other HMO |
$930.42
|
| Rate for Payer: United Healthcare HMO Rider |
$910.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$834.14
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
915355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$646.32 |
| Max. Negotiated Rate |
$2,289.05 |
| Rate for Payer: Adventist Health Commercial |
$1,104.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,481.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,559.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,987.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,289.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,093.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,885.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,885.10
|
| Rate for Payer: Multiplan Commercial |
$2,154.40
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.05
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$646.32 |
| Max. Negotiated Rate |
$2,289.05 |
| Rate for Payer: Adventist Health Commercial |
$1,104.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,481.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,019.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,559.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,987.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,289.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,093.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,885.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,885.10
|
| Rate for Payer: Multiplan Commercial |
$2,154.40
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,615.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,289.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.05
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
905355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.32
|
| Rate for Payer: Multiplan Commercial |
$2,154.40
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
|
|
HC HD ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$2,693.00
|
|
|
Service Code
|
CPT L5966
|
| Hospital Charge Code |
915355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cash Price |
$1,481.15
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,077.20
|
| Rate for Payer: Galaxy Health WC |
$2,289.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,615.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,796.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,026.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,666.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.32
|
| Rate for Payer: Multiplan Commercial |
$2,154.40
|
| Rate for Payer: Networks By Design Commercial |
$1,346.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,289.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,010.68
|
| Rate for Payer: United Healthcare All Other HMO |
$983.75
|
| Rate for Payer: United Healthcare HMO Rider |
$962.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.96
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
915355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
915355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Adventist Health Commercial |
$336.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.52
|
| Rate for Payer: Blue Shield of California Commercial |
$605.90
|
| Rate for Payer: Blue Shield of California EPN |
$399.01
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$574.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$574.70
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Adventist Health Commercial |
$336.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$475.52
|
| Rate for Payer: Blue Shield of California Commercial |
$605.90
|
| Rate for Payer: Blue Shield of California EPN |
$399.01
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$574.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$574.70
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.85
|
| Rate for Payer: Vantage Medical Group Senior |
$697.85
|
|
|
HC HD ADD HIP EXTENSION ASSIST
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
905355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cash Price |
$451.55
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: EPIC Health Plan Senior |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$508.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$410.50
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$308.12
|
| Rate for Payer: United Healthcare All Other HMO |
$299.91
|
| Rate for Payer: United Healthcare HMO Rider |
$293.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$268.88
|
|
