|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
915355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$1,917.00 |
| Rate for Payer: Adventist Health Commercial |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.52
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,704.00
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,917.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.00
|
| Rate for Payer: Multiplan Commercial |
$1,597.50
|
| Rate for Payer: Networks By Design Commercial |
$1,384.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
915355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$697.58 |
| Max. Negotiated Rate |
$1,917.00 |
| Rate for Payer: Networks By Design Commercial |
$1,065.00
|
| Rate for Payer: Adventist Health Commercial |
$873.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,171.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,597.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,239.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.52
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,704.00
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,810.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,810.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,917.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$810.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$894.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$873.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,491.00
|
| Rate for Payer: Multiplan Commercial |
$1,597.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: Riverside University Health System MISP |
$852.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,278.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,810.50
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
905355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$1,917.00 |
| Rate for Payer: Adventist Health Commercial |
$426.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.52
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,704.00
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,917.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.00
|
| Rate for Payer: Multiplan Commercial |
$1,597.50
|
| Rate for Payer: Networks By Design Commercial |
$1,384.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
905355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$697.58 |
| Max. Negotiated Rate |
$1,917.00 |
| Rate for Payer: Adventist Health Commercial |
$873.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,171.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,597.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,239.02
|
| Rate for Payer: Blue Shield of California Commercial |
$1,708.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,073.52
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,704.00
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,810.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,810.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Senior |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,917.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$810.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,352.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$894.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$873.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,491.00
|
| Rate for Payer: Multiplan Commercial |
$1,597.50
|
| Rate for Payer: Networks By Design Commercial |
$1,065.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: Riverside University Health System MISP |
$852.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,278.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$799.39
|
| Rate for Payer: United Healthcare All Other HMO |
$778.09
|
| Rate for Payer: United Healthcare HMO Rider |
$761.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$697.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,810.50
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
915355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.51 |
| Max. Negotiated Rate |
$1,463.40 |
| Rate for Payer: Adventist Health Commercial |
$666.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,219.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,304.05
|
| Rate for Payer: Blue Shield of California EPN |
$819.50
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.80
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,382.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,382.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$863.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$954.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,138.20
|
| Rate for Payer: Multiplan Commercial |
$1,219.50
|
| Rate for Payer: Networks By Design Commercial |
$813.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: Riverside University Health System MISP |
$650.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,382.10
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
905355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$532.51 |
| Max. Negotiated Rate |
$1,463.40 |
| Rate for Payer: Adventist Health Commercial |
$666.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,219.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.84
|
| Rate for Payer: Blue Shield of California Commercial |
$1,304.05
|
| Rate for Payer: Blue Shield of California EPN |
$819.50
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.80
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,382.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,382.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$863.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$954.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,138.20
|
| Rate for Payer: Multiplan Commercial |
$1,219.50
|
| Rate for Payer: Networks By Design Commercial |
$813.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: Riverside University Health System MISP |
$650.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,382.10
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
915355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$1,463.40 |
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: Adventist Health Commercial |
$325.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,304.05
|
| Rate for Payer: Blue Shield of California EPN |
$819.50
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.80
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.20
|
| Rate for Payer: Multiplan Commercial |
$1,219.50
|
| Rate for Payer: Networks By Design Commercial |
$1,056.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
905355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$1,463.40 |
| Rate for Payer: Adventist Health Commercial |
$325.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,304.05
|
| Rate for Payer: Blue Shield of California EPN |
$819.50
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.80
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Senior |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,032.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$959.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.20
|
| Rate for Payer: Multiplan Commercial |
$1,219.50
|
| Rate for Payer: Networks By Design Commercial |
$1,056.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.24
|
| Rate for Payer: United Healthcare All Other HMO |
$593.98
|
| Rate for Payer: United Healthcare HMO Rider |
$581.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.51
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
OP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
915355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,902.72 |
| Max. Negotiated Rate |
$8,522.10 |
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.65
|
| Rate for Payer: Adventist Health Commercial |
$3,882.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,207.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,101.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,508.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,594.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,772.38
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,575.20
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,048.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,522.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,902.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,206.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,882.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,628.30
|
| Rate for Payer: Multiplan Commercial |
$7,101.75
|
| Rate for Payer: Networks By Design Commercial |
$4,734.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,787.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,681.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,681.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,048.65
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
IP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
905355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,893.80 |
| Max. Negotiated Rate |
$8,522.10 |
| Rate for Payer: Adventist Health Commercial |
$1,893.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,594.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,772.38
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,575.20
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,522.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,893.80
|
| Rate for Payer: Multiplan Commercial |
$7,101.75
|
| Rate for Payer: Networks By Design Commercial |
$6,154.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
OP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
905355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,902.72 |
| Max. Negotiated Rate |
$8,522.10 |
| Rate for Payer: Adventist Health Commercial |
$3,882.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,207.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,101.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,508.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,594.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,772.38
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,575.20
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,048.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,522.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,902.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,206.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,882.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,628.30
|
| Rate for Payer: Multiplan Commercial |
$7,101.75
|
| Rate for Payer: Networks By Design Commercial |
$4,734.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,787.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,681.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,681.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,048.65
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
IP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
915355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,893.80 |
| Max. Negotiated Rate |
$8,522.10 |
| Rate for Payer: Adventist Health Commercial |
$1,893.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,594.14
|
| Rate for Payer: Blue Shield of California EPN |
$4,772.38
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,575.20
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,522.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,012.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,586.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,893.80
|
| Rate for Payer: Multiplan Commercial |
$7,101.75
|
| Rate for Payer: Networks By Design Commercial |
$6,154.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.72
|
| Rate for Payer: United Healthcare All Other HMO |
$3,459.03
|
| Rate for Payer: United Healthcare HMO Rider |
$3,384.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,101.10
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
OP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
915355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,078.13 |
| Max. Negotiated Rate |
$2,962.80 |
| Rate for Payer: Adventist Health Commercial |
$1,349.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,810.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,469.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,914.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2,640.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,659.17
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,633.60
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,798.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,798.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,962.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,426.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,575.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,349.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,304.40
|
| Rate for Payer: Multiplan Commercial |
$2,469.00
|
| Rate for Payer: Networks By Design Commercial |
$1,646.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,798.20
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
OP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
905355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,078.13 |
| Max. Negotiated Rate |
$2,962.80 |
| Rate for Payer: Adventist Health Commercial |
$1,349.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,810.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,469.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,914.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2,640.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,659.17
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,633.60
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,798.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,798.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,962.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,426.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,575.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,349.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,304.40
|
| Rate for Payer: Multiplan Commercial |
$2,469.00
|
| Rate for Payer: Networks By Design Commercial |
$1,646.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,798.20
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
IP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
905355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$658.40 |
| Max. Negotiated Rate |
$2,962.80 |
| Rate for Payer: Adventist Health Commercial |
$658.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,640.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,659.17
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,633.60
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,962.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.40
|
| Rate for Payer: Multiplan Commercial |
$2,469.00
|
| Rate for Payer: Networks By Design Commercial |
$2,139.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
IP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
915355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$658.40 |
| Max. Negotiated Rate |
$2,962.80 |
| Rate for Payer: United Healthcare HMO Rider |
$1,176.56
|
| Rate for Payer: Adventist Health Commercial |
$658.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,640.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,659.17
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,633.60
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,962.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,090.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,942.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.40
|
| Rate for Payer: Multiplan Commercial |
$2,469.00
|
| Rate for Payer: Networks By Design Commercial |
$2,139.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,235.49
|
| Rate for Payer: United Healthcare All Other HMO |
$1,202.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,078.13
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
915355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Blue Shield of California Commercial |
$688.92
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.80
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$558.35
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.68
|
| Rate for Payer: Blue Shield of California Commercial |
$688.92
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Riverside University Health System MISP |
$343.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$171.80
|
| Rate for Payer: Blue Shield of California Commercial |
$688.92
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.80
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$558.35
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
915355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$281.32 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Adventist Health Commercial |
$352.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$644.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.68
|
| Rate for Payer: Blue Shield of California Commercial |
$688.92
|
| Rate for Payer: Blue Shield of California EPN |
$432.94
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$730.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Senior |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$545.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$506.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.30
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Riverside University Health System MISP |
$343.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$322.38
|
| Rate for Payer: United Healthcare All Other HMO |
$313.79
|
| Rate for Payer: United Healthcare HMO Rider |
$307.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
915355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$379.76 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$379.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$419.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health System MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$379.76 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$517.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$947.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$734.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,073.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$379.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$419.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$884.10
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health System MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
915355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Adventist Health Commercial |
$252.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.93
|
| Rate for Payer: Blue Shield of California EPN |
$636.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Senior |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$802.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$474.00
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$413.63
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
OP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
905355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,935.45 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Adventist Health Commercial |
$4,592.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,160.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,515.04
|
| Rate for Payer: Blue Shield of California Commercial |
$8,982.40
|
| Rate for Payer: Blue Shield of California EPN |
$5,644.80
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,960.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,520.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,520.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,080.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,935.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,112.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,137.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,608.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,592.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,840.00
|
| Rate for Payer: Multiplan Commercial |
$8,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,480.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,203.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4,002.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,668.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,520.00
|
|
