|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
915355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Adventist Health Commercial |
$1,713.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,872.34
|
| Rate for Payer: Blue Shield of California EPN |
$4,318.78
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,998.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,441.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,055.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.80
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$5,569.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,215.95
|
| Rate for Payer: United Healthcare All Other HMO |
$3,130.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3,062.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,806.35
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Adventist Health Commercial |
$52.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$103.46
|
| Rate for Payer: Blue Shield of California EPN |
$65.02
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$64.50
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.41
|
| Rate for Payer: United Healthcare All Other HMO |
$47.12
|
| Rate for Payer: United Healthcare HMO Rider |
$46.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
915355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.31 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Adventist Health Commercial |
$165.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.01
|
| Rate for Payer: Blue Shield of California Commercial |
$324.01
|
| Rate for Payer: Blue Shield of California EPN |
$203.62
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$162.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$202.00
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Riverside University Health System MISP |
$161.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Blue Shield of California Commercial |
$103.46
|
| Rate for Payer: Blue Shield of California EPN |
$65.02
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.41
|
| Rate for Payer: United Healthcare All Other HMO |
$47.12
|
| Rate for Payer: United Healthcare HMO Rider |
$46.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.25
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
915355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Blue Shield of California Commercial |
$324.01
|
| Rate for Payer: Blue Shield of California EPN |
$203.62
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
915355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Adventist Health Commercial |
$187.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.42
|
| Rate for Payer: Blue Shield of California Commercial |
$367.32
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$389.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Riverside University Health System MISP |
$183.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
915355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Blue Shield of California Commercial |
$367.32
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$297.70
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Adventist Health Commercial |
$187.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$343.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$266.42
|
| Rate for Payer: Blue Shield of California Commercial |
$367.32
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$389.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Riverside University Health System MISP |
$183.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Adventist Health Commercial |
$91.60
|
| Rate for Payer: Blue Shield of California Commercial |
$367.32
|
| Rate for Payer: Blue Shield of California EPN |
$230.83
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Senior |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$290.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$270.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$297.70
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$171.89
|
| Rate for Payer: United Healthcare All Other HMO |
$167.31
|
| Rate for Payer: United Healthcare HMO Rider |
$163.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$149.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.32
|
| Rate for Payer: Blue Shield of California Commercial |
$292.73
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$255.50
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Riverside University Health System MISP |
$146.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Blue Shield of California Commercial |
$292.73
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
915355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: Adventist Health Commercial |
$149.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.32
|
| Rate for Payer: Blue Shield of California Commercial |
$292.73
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$255.50
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Riverside University Health System MISP |
$146.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
915355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Blue Shield of California Commercial |
$292.73
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
IP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
905355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,311.40 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,258.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,304.73
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,163.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,868.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.40
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Networks By Design Commercial |
$4,262.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
OP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
915355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,147.42 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Adventist Health Commercial |
$2,688.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,606.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,917.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,814.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5,258.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,304.73
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,573.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,573.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,791.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,163.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,084.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,868.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,688.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,589.90
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,622.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,934.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,934.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,573.45
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
OP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
905355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,147.42 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Adventist Health Commercial |
$2,688.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,606.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,917.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,814.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5,258.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,304.73
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,573.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,573.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,791.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,163.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,084.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,868.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,688.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,589.90
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,622.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,934.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,934.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,573.45
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
IP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
915355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,311.40 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Adventist Health Commercial |
$1,311.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,258.71
|
| Rate for Payer: Blue Shield of California EPN |
$3,304.73
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,163.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,868.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.40
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Networks By Design Commercial |
$4,262.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,460.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,395.27
|
| Rate for Payer: United Healthcare HMO Rider |
$2,343.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,147.42
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
915355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$874.75 |
| Max. Negotiated Rate |
$2,403.90 |
| Rate for Payer: Networks By Design Commercial |
$1,335.50
|
| Rate for Payer: Adventist Health Commercial |
$1,095.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,469.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,553.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,142.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.18
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,136.80
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,270.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,270.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,869.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,403.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,253.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,696.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,384.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,575.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,869.70
|
| Rate for Payer: Multiplan Commercial |
$2,003.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,068.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,602.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,602.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.43
|
| Rate for Payer: United Healthcare All Other HMO |
$975.72
|
| Rate for Payer: United Healthcare HMO Rider |
$954.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,270.35
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
IP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
915355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$534.20 |
| Max. Negotiated Rate |
$2,403.90 |
| Rate for Payer: Adventist Health Commercial |
$534.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,142.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.18
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,136.80
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,869.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,403.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,696.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,575.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.20
|
| Rate for Payer: Multiplan Commercial |
$2,003.25
|
| Rate for Payer: Networks By Design Commercial |
$1,736.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.43
|
| Rate for Payer: United Healthcare All Other HMO |
$975.72
|
| Rate for Payer: United Healthcare HMO Rider |
$954.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.75
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
905355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$874.75 |
| Max. Negotiated Rate |
$2,403.90 |
| Rate for Payer: Adventist Health Commercial |
$1,095.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,469.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,553.72
|
| Rate for Payer: Blue Shield of California Commercial |
$2,142.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.18
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,136.80
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,270.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,270.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,869.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,403.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,253.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,696.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,384.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,575.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,869.70
|
| Rate for Payer: Multiplan Commercial |
$2,003.25
|
| Rate for Payer: Networks By Design Commercial |
$1,335.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,068.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,602.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,602.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.43
|
| Rate for Payer: United Healthcare All Other HMO |
$975.72
|
| Rate for Payer: United Healthcare HMO Rider |
$954.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,270.35
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
IP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
905355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$534.20 |
| Max. Negotiated Rate |
$2,403.90 |
| Rate for Payer: Adventist Health Commercial |
$534.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,142.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,346.18
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,136.80
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,869.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,403.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,696.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,575.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.20
|
| Rate for Payer: Multiplan Commercial |
$2,003.25
|
| Rate for Payer: Networks By Design Commercial |
$1,736.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,002.43
|
| Rate for Payer: United Healthcare All Other HMO |
$975.72
|
| Rate for Payer: United Healthcare HMO Rider |
$954.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$874.75
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
OP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
905355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$2,222.10 |
| Rate for Payer: Adventist Health Commercial |
$1,012.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,357.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,851.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,436.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,980.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.38
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,975.20
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,098.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,098.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,728.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,222.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,185.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,567.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,728.30
|
| Rate for Payer: Multiplan Commercial |
$1,851.75
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: Riverside University Health System MISP |
$987.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,481.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,481.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,098.65
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
OP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
915355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.60 |
| Max. Negotiated Rate |
$2,222.10 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,098.65
|
| Rate for Payer: Adventist Health Commercial |
$1,012.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,357.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,851.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,436.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,980.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.38
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,975.20
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,098.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,728.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,222.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,185.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,567.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,728.30
|
| Rate for Payer: Multiplan Commercial |
$1,851.75
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: Riverside University Health System MISP |
$987.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,481.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,481.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,098.65
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
IP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
905355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$493.80 |
| Max. Negotiated Rate |
$2,222.10 |
| Rate for Payer: Adventist Health Commercial |
$493.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,980.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.38
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,975.20
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,728.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,222.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,567.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.80
|
| Rate for Payer: Multiplan Commercial |
$1,851.75
|
| Rate for Payer: Networks By Design Commercial |
$1,604.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
IP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
915355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$493.80 |
| Max. Negotiated Rate |
$2,222.10 |
| Rate for Payer: Adventist Health Commercial |
$493.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,980.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,244.38
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,975.20
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,728.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,222.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,567.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.80
|
| Rate for Payer: Multiplan Commercial |
$1,851.75
|
| Rate for Payer: Networks By Design Commercial |
$1,604.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.62
|
| Rate for Payer: United Healthcare All Other HMO |
$901.93
|
| Rate for Payer: United Healthcare HMO Rider |
$882.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$808.60
|
|
