|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
IP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
905355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,810.80 |
| Max. Negotiated Rate |
$8,148.60 |
| Rate for Payer: Adventist Health Commercial |
$1,810.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,261.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,563.22
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,243.20
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,337.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,148.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,749.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,341.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,810.80
|
| Rate for Payer: Multiplan Commercial |
$6,790.50
|
| Rate for Payer: Networks By Design Commercial |
$5,885.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,397.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,965.18
|
|
|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
IP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
915355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,810.80 |
| Max. Negotiated Rate |
$8,148.60 |
| Rate for Payer: Adventist Health Commercial |
$1,810.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,261.31
|
| Rate for Payer: Blue Shield of California EPN |
$4,563.22
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,243.20
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,337.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,148.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,749.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,341.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,810.80
|
| Rate for Payer: Multiplan Commercial |
$6,790.50
|
| Rate for Payer: Networks By Design Commercial |
$5,885.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,397.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,307.43
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,965.18
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
IP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
905355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,634.80 |
| Max. Negotiated Rate |
$11,856.60 |
| Rate for Payer: Adventist Health Commercial |
$2,634.80
|
| Rate for Payer: Blue Shield of California Commercial |
$10,565.55
|
| Rate for Payer: Blue Shield of California EPN |
$6,639.70
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,539.20
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,856.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,365.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,772.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,634.80
|
| Rate for Payer: Multiplan Commercial |
$9,880.50
|
| Rate for Payer: Networks By Design Commercial |
$8,563.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
OP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
915355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,828.03 |
| Max. Negotiated Rate |
$11,856.60 |
| Rate for Payer: Adventist Health Commercial |
$5,401.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,245.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,663.32
|
| Rate for Payer: Blue Shield of California Commercial |
$10,565.55
|
| Rate for Payer: Blue Shield of California EPN |
$6,639.70
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,539.20
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,197.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,197.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,856.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,828.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,365.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,019.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,772.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,401.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,221.80
|
| Rate for Payer: Multiplan Commercial |
$9,880.50
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: Riverside University Health System MISP |
$5,269.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,904.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,904.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11,197.90
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
OP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
905355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,828.03 |
| Max. Negotiated Rate |
$11,856.60 |
| Rate for Payer: Adventist Health Commercial |
$5,401.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,245.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,880.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,663.32
|
| Rate for Payer: Blue Shield of California Commercial |
$10,565.55
|
| Rate for Payer: Blue Shield of California EPN |
$6,639.70
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,539.20
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,197.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,197.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,856.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,828.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,365.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,019.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,772.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,401.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,221.80
|
| Rate for Payer: Multiplan Commercial |
$9,880.50
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: Riverside University Health System MISP |
$5,269.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,904.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,904.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11,197.90
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
IP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
915355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,634.80 |
| Max. Negotiated Rate |
$11,856.60 |
| Rate for Payer: Adventist Health Commercial |
$2,634.80
|
| Rate for Payer: Blue Shield of California Commercial |
$10,565.55
|
| Rate for Payer: Blue Shield of California EPN |
$6,639.70
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,539.20
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,856.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,365.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,772.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,634.80
|
| Rate for Payer: Multiplan Commercial |
$9,880.50
|
| Rate for Payer: Networks By Design Commercial |
$8,563.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,944.20
|
| Rate for Payer: United Healthcare All Other HMO |
$4,812.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4,708.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,314.48
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
915355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$492.40 |
| Max. Negotiated Rate |
$2,215.80 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,240.85
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,969.60
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,215.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,563.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,452.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.40
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Networks By Design Commercial |
$1,600.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
905355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$780.38 |
| Max. Negotiated Rate |
$2,215.80 |
| Rate for Payer: Adventist Health Commercial |
$1,009.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,354.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,432.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,240.85
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,969.60
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,092.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,092.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,215.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$780.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,563.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,452.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,723.40
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: Riverside University Health System MISP |
$984.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,477.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,477.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,092.70
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
905355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$492.40 |
| Max. Negotiated Rate |
$2,215.80 |
| Rate for Payer: Adventist Health Commercial |
$492.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,240.85
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,969.60
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,215.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,563.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,452.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.40
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Networks By Design Commercial |
$1,600.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
915355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$780.38 |
| Max. Negotiated Rate |
$2,215.80 |
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: Adventist Health Commercial |
$1,009.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,354.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,846.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,432.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,974.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,240.85
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,969.60
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,092.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,092.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Senior |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,215.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$780.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,563.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$862.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,452.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,723.40
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: Riverside University Health System MISP |
$984.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,477.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,477.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$923.99
|
| Rate for Payer: United Healthcare All Other HMO |
$899.37
|
| Rate for Payer: United Healthcare HMO Rider |
$879.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,092.70
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
905355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,408.31
|
| Rate for Payer: Blue Shield of California EPN |
$885.02
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,229.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,115.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,036.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.20
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$1,141.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
915355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Adventist Health Commercial |
$351.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,408.31
|
| Rate for Payer: Blue Shield of California EPN |
$885.02
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,229.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,115.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,036.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.20
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$1,141.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
905355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$497.08 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Adventist Health Commercial |
$719.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,317.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,021.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,408.31
|
| Rate for Payer: Blue Shield of California EPN |
$885.02
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,492.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,492.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,229.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$497.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,115.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$549.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,036.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,229.20
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: Riverside University Health System MISP |
$702.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,053.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,492.60
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
915355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$497.08 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Adventist Health Commercial |
$719.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,317.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,021.47
|
| Rate for Payer: Blue Shield of California Commercial |
$1,408.31
|
| Rate for Payer: Blue Shield of California EPN |
$885.02
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,492.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,492.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,229.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Senior |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$497.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,115.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$549.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,036.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,229.20
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: Riverside University Health System MISP |
$702.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,053.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$659.03
|
| Rate for Payer: United Healthcare All Other HMO |
$641.47
|
| Rate for Payer: United Healthcare HMO Rider |
$627.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,492.60
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
915355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,055.80 |
| Max. Negotiated Rate |
$4,751.10 |
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: Adventist Health Commercial |
$1,055.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,233.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,660.62
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,751.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,352.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,114.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.80
|
| Rate for Payer: Multiplan Commercial |
$3,959.25
|
| Rate for Payer: Networks By Design Commercial |
$3,431.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
905355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,055.80 |
| Max. Negotiated Rate |
$4,751.10 |
| Rate for Payer: Adventist Health Commercial |
$1,055.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,233.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,660.62
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,751.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,352.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,114.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.80
|
| Rate for Payer: Multiplan Commercial |
$3,959.25
|
| Rate for Payer: Networks By Design Commercial |
$3,431.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
905355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$718.91 |
| Max. Negotiated Rate |
$4,751.10 |
| Rate for Payer: Adventist Health Commercial |
$2,164.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,903.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,959.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,070.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,233.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,660.62
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,487.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,487.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,751.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$718.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,352.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$794.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,114.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,695.30
|
| Rate for Payer: Multiplan Commercial |
$3,959.25
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,167.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,487.15
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
915355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$718.91 |
| Max. Negotiated Rate |
$4,751.10 |
| Rate for Payer: Adventist Health Commercial |
$2,164.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,903.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,959.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,070.79
|
| Rate for Payer: Blue Shield of California Commercial |
$4,233.76
|
| Rate for Payer: Blue Shield of California EPN |
$2,660.62
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,487.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,487.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,751.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$718.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,352.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$794.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,114.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,695.30
|
| Rate for Payer: Multiplan Commercial |
$3,959.25
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,167.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,487.15
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
905355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$331.43 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$414.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.68
|
| Rate for Payer: Blue Shield of California Commercial |
$811.62
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$618.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$682.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
915355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Blue Shield of California Commercial |
$811.62
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
915355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$331.43 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Adventist Health Commercial |
$414.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.68
|
| Rate for Payer: Blue Shield of California Commercial |
$811.62
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$618.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$682.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
905355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Blue Shield of California Commercial |
$811.62
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
915355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Blue Shield of California Commercial |
$507.67
|
| Rate for Payer: Blue Shield of California EPN |
$319.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.60
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
905355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.31 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Adventist Health Commercial |
$259.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.22
|
| Rate for Payer: Blue Shield of California Commercial |
$507.67
|
| Rate for Payer: Blue Shield of California EPN |
$319.03
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$293.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$443.10
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$316.50
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Riverside University Health System MISP |
$253.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.05
|
| Rate for Payer: Vantage Medical Group Senior |
$538.05
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
905355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Blue Shield of California Commercial |
$507.67
|
| Rate for Payer: Blue Shield of California EPN |
$319.03
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$373.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.60
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
|
