|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$638.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cigna of CA HMO |
$2,235.10
|
| Rate for Payer: Cigna of CA PPO |
$2,235.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| 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 |
$2,075.45
|
| 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 |
$1,932.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,455.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,618.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$944.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| 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 |
$1,932.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,455.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,618.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| Rate for Payer: Cash Price |
$1,436.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$944.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,027.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,068.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,883.87
|
| 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 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 |
$3,270.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4,154.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,739.32
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$897.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| 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 |
905355795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| 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 |
$3,511.95
|
| 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
|
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 |
$3,270.44
|
| Rate for Payer: Blue Shield of California Commercial |
$4,154.91
|
| Rate for Payer: Blue Shield of California Commercial |
$2,739.32
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$897.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,014.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,782.10
|
| Rate for Payer: Cigna of CA PPO |
$3,782.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| 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 |
$3,511.95
|
| 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
|
IP
|
$2,547.00
|
|
|
Service Code
|
CPT L5643
|
| Hospital Charge Code |
915355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| 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 |
$1,655.55
|
| 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
|
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 |
$1,541.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,958.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,291.33
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,159.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| 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 |
$1,541.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,958.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,291.33
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,159.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,311.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| 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 |
905355643
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$509.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$509.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cash Price |
$1,146.15
|
| Rate for Payer: Cigna of CA HMO |
$1,782.90
|
| Rate for Payer: Cigna of CA PPO |
$1,782.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,617.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,502.73
|
| 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 |
$1,655.55
|
| 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 |
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 |
$1,630.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,070.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,365.35
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cash Price |
$1,211.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,093.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| 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 |
$1,750.45
|
| 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
|
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 |
$1,630.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,070.92
|
| Rate for Payer: Blue Shield of California Commercial |
$1,365.35
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cash Price |
$1,211.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,093.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,236.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| 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 |
915355966
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$538.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cash Price |
$1,211.85
|
| Rate for Payer: Cigna of CA HMO |
$1,885.10
|
| Rate for Payer: Cigna of CA PPO |
$1,885.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,710.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,588.87
|
| 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 |
$1,750.45
|
| 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
|
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 |
$496.95
|
| Rate for Payer: Blue Shield of California Commercial |
$631.35
|
| Rate for Payer: Blue Shield of California Commercial |
$416.25
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$521.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$484.39
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$521.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$484.39
|
| 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 |
$533.65
|
| 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
|
IP
|
$821.00
|
|
|
Service Code
|
CPT L5855
|
| Hospital Charge Code |
915355855
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$164.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$164.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cigna of CA HMO |
$574.70
|
| Rate for Payer: Cigna of CA PPO |
$574.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$521.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$484.39
|
| 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 |
$533.65
|
| 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 |
$496.95
|
| Rate for Payer: Blue Shield of California Commercial |
$631.35
|
| Rate for Payer: Blue Shield of California Commercial |
$416.25
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$521.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$484.39
|
| 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 ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
915355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
915355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.95
|
| Rate for Payer: Blue Shield of California Commercial |
$572.90
|
| Rate for Payer: Blue Shield of California Commercial |
$377.71
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HD ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5626
|
| Hospital Charge Code |
905355626
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.95
|
| Rate for Payer: Blue Shield of California Commercial |
$572.90
|
| Rate for Payer: Blue Shield of California Commercial |
$377.71
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,063.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3,063.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$6,893.10
|
| Rate for Payer: Cash Price |
$6,893.10
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,722.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,726.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,037.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,676.32
|
| Rate for Payer: Multiplan Commercial |
$12,254.40
|
| Rate for Payer: Networks By Design Commercial |
$9,956.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
|
|
HC HD CANADIAN TYPE ENDOSKELETAL
|
Facility
|
OP
|
$15,318.00
|
|
|
Service Code
|
CPT L5331
|
| Hospital Charge Code |
915355330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,676.32 |
| Max. Negotiated Rate |
$13,020.30 |
| Rate for Payer: Adventist Health Commercial |
$6,280.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,424.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,488.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,271.99
|
| Rate for Payer: Blue Shield of California Commercial |
$7,766.23
|
| Rate for Payer: Blue Shield of California Commercial |
$11,779.54
|
| Rate for Payer: Cash Price |
$6,893.10
|
| Rate for Payer: Cash Price |
$6,893.10
|
| Rate for Payer: Cigna of CA HMO |
$10,722.60
|
| Rate for Payer: Cigna of CA PPO |
$10,722.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,020.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,020.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,722.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,127.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,127.20
|
| Rate for Payer: Galaxy Health WC |
$13,020.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,190.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,277.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,726.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,099.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,037.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,676.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,722.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,722.60
|
| Rate for Payer: Multiplan Commercial |
$12,254.40
|
| Rate for Payer: Networks By Design Commercial |
$7,659.00
|
| Rate for Payer: Prime Health Services Commercial |
$13,020.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,190.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,190.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,748.85
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.67
|
| Rate for Payer: United Healthcare HMO Rider |
$5,474.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,016.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,020.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13,020.30
|
|
