|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
915355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$718.91 |
| Max. Negotiated Rate |
$4,751.10 |
| Rate for Payer: Adventist Health Commercial |
$2,164.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,903.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,959.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,100.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,080.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,660.62
|
| Rate for Payer: Cash Price |
$2,903.45
|
| Rate for Payer: Cash Price |
$2,903.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,487.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,487.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,751.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$718.91
|
| Rate for Payer: InnovAge PACE Commercial |
$2,639.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,695.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,695.30
|
| Rate for Payer: Multiplan Commercial |
$3,959.25
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,167.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,487.15
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
905355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,055.80 |
| Max. Negotiated Rate |
$4,751.10 |
| Rate for Payer: Adventist Health Commercial |
$1,055.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,080.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,660.62
|
| Rate for Payer: Cash Price |
$2,903.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,751.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,011.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.80
|
| Rate for Payer: Multiplan Commercial |
$3,959.25
|
| Rate for Payer: Networks By Design Commercial |
$3,431.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
905355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$718.91 |
| Max. Negotiated Rate |
$4,751.10 |
| Rate for Payer: Adventist Health Commercial |
$2,164.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,903.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,959.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,100.36
|
| Rate for Payer: Blue Shield of California Commercial |
$4,080.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,660.62
|
| Rate for Payer: Cash Price |
$2,903.45
|
| Rate for Payer: Cash Price |
$2,903.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,487.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,487.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,111.60
|
| Rate for Payer: Galaxy Health WC |
$4,487.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,167.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,751.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$718.91
|
| Rate for Payer: InnovAge PACE Commercial |
$2,639.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$794.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,267.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,164.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,695.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,695.30
|
| Rate for Payer: Multiplan Commercial |
$3,959.25
|
| Rate for Payer: Networks By Design Commercial |
$2,639.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,487.15
|
| Rate for Payer: Riverside University Health System MISP |
$2,111.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,167.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,167.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,981.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,928.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,886.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,728.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,487.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,487.15
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
905355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$331.43 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$414.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.35
|
| Rate for Payer: Blue Shield of California Commercial |
$782.28
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$618.13
|
| Rate for Payer: InnovAge PACE Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
915355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Blue Shield of California Commercial |
$782.28
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
915355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$331.43 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$414.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.35
|
| Rate for Payer: Blue Shield of California Commercial |
$782.28
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$618.13
|
| Rate for Payer: InnovAge PACE Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC AK ADD EXOSKEL SINGLE AXIS ULT
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT L5711
|
| Hospital Charge Code |
905355711
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Blue Shield of California Commercial |
$782.28
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
905355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Blue Shield of California Commercial |
$489.31
|
| Rate for Payer: Blue Shield of California EPN |
$319.03
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.60
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
915355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.31 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Adventist Health Commercial |
$259.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.76
|
| Rate for Payer: Blue Shield of California Commercial |
$489.31
|
| Rate for Payer: Blue Shield of California EPN |
$319.03
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$293.54
|
| Rate for Payer: InnovAge PACE Commercial |
$316.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.10
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$316.50
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Riverside University Health System MISP |
$253.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.05
|
| Rate for Payer: Vantage Medical Group Senior |
$538.05
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
905355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.31 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Adventist Health Commercial |
$259.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$474.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$371.76
|
| Rate for Payer: Blue Shield of California Commercial |
$489.31
|
| Rate for Payer: Blue Shield of California EPN |
$319.03
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$538.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$538.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$293.54
|
| Rate for Payer: InnovAge PACE Commercial |
$316.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$443.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$443.10
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$316.50
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Riverside University Health System MISP |
$253.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.05
|
| Rate for Payer: Vantage Medical Group Senior |
$538.05
|
|
|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
IP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
915355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.60 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Adventist Health Commercial |
$126.60
|
| Rate for Payer: Blue Shield of California Commercial |
$489.31
|
| Rate for Payer: Blue Shield of California EPN |
$319.03
|
| Rate for Payer: Cash Price |
$348.15
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$253.20
|
| Rate for Payer: Galaxy Health WC |
$538.05
|
| Rate for Payer: Global Benefits Group Commercial |
$379.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$569.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$391.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.60
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$411.45
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.56
|
| Rate for Payer: United Healthcare All Other HMO |
$231.23
|
| Rate for Payer: United Healthcare HMO Rider |
$226.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.31
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
IP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
915355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,351.00 |
| Max. Negotiated Rate |
$6,079.50 |
| Rate for Payer: Adventist Health Commercial |
$1,351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,221.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,404.52
|
| Rate for Payer: Cash Price |
$3,715.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,404.00
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,079.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,505.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,573.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,181.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$5,066.25
|
| Rate for Payer: Networks By Design Commercial |
$4,390.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
OP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
905355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,176.40 |
| Max. Negotiated Rate |
$6,079.50 |
| Rate for Payer: Adventist Health Commercial |
$2,769.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,715.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,066.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,967.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5,221.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,404.52
|
| Rate for Payer: Cash Price |
$3,715.25
|
| Rate for Payer: Cash Price |
$3,715.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,404.00
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,741.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,741.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,079.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,176.40
|
| Rate for Payer: InnovAge PACE Commercial |
$3,377.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,505.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,404.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,181.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,728.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,728.50
|
| Rate for Payer: Multiplan Commercial |
$5,066.25
|
| Rate for Payer: Networks By Design Commercial |
$3,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,741.75
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
OP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
915355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,176.40 |
| Max. Negotiated Rate |
$6,079.50 |
| Rate for Payer: Adventist Health Commercial |
$2,769.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,715.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,066.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,967.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5,221.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,404.52
|
| Rate for Payer: Cash Price |
$3,715.25
|
| Rate for Payer: Cash Price |
$3,715.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,404.00
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,741.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,741.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,079.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,176.40
|
| Rate for Payer: InnovAge PACE Commercial |
$3,377.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,505.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,404.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,181.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,728.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,728.50
|
| Rate for Payer: Multiplan Commercial |
$5,066.25
|
| Rate for Payer: Networks By Design Commercial |
$3,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,741.75
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
IP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
905355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,351.00 |
| Max. Negotiated Rate |
$6,079.50 |
| Rate for Payer: Adventist Health Commercial |
$1,351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,221.61
|
| Rate for Payer: Blue Shield of California EPN |
$3,404.52
|
| Rate for Payer: Cash Price |
$3,715.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,404.00
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,079.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,505.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,573.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,181.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$5,066.25
|
| Rate for Payer: Networks By Design Commercial |
$4,390.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,535.15
|
| Rate for Payer: United Healthcare All Other HMO |
$2,467.60
|
| Rate for Payer: United Healthcare HMO Rider |
$2,414.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,212.26
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
905355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.06 |
| Max. Negotiated Rate |
$5,574.60 |
| Rate for Payer: Adventist Health Commercial |
$2,539.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,406.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,637.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4,787.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,121.78
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,955.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,264.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,264.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,574.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,249.06
|
| Rate for Payer: InnovAge PACE Commercial |
$3,097.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,379.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,834.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,335.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,335.80
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: Networks By Design Commercial |
$3,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,477.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,716.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,716.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,264.90
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
915355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,238.80 |
| Max. Negotiated Rate |
$5,574.60 |
| Rate for Payer: Adventist Health Commercial |
$1,238.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,787.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,121.78
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,955.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,574.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,834.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,238.80
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: Networks By Design Commercial |
$4,026.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
905355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,238.80 |
| Max. Negotiated Rate |
$5,574.60 |
| Rate for Payer: Adventist Health Commercial |
$1,238.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,787.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,121.78
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,955.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,574.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,834.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,238.80
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: Networks By Design Commercial |
$4,026.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
915355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,249.06 |
| Max. Negotiated Rate |
$5,574.60 |
| Rate for Payer: Adventist Health Commercial |
$2,539.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,406.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,645.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,637.74
|
| Rate for Payer: Blue Shield of California Commercial |
$4,787.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,121.78
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Cash Price |
$3,406.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,955.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,264.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,264.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,574.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,249.06
|
| Rate for Payer: InnovAge PACE Commercial |
$3,097.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,379.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,834.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,335.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,335.80
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: Networks By Design Commercial |
$3,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,477.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,716.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,716.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,324.61
|
| Rate for Payer: United Healthcare All Other HMO |
$2,262.67
|
| Rate for Payer: United Healthcare HMO Rider |
$2,213.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,028.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,264.90
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
905355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.40 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: Adventist Health Commercial |
$477.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.05
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,909.60
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,148.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,477.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$1,790.25
|
| Rate for Payer: Networks By Design Commercial |
$1,551.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
915355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$781.74 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: Adventist Health Commercial |
$978.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,312.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,790.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,401.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.05
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,909.60
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,028.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,028.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,148.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,193.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,477.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,670.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,670.90
|
| Rate for Payer: Multiplan Commercial |
$1,790.25
|
| Rate for Payer: Networks By Design Commercial |
$1,193.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: Riverside University Health System MISP |
$954.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,432.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,028.95
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
915355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.40 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: Adventist Health Commercial |
$477.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.05
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,909.60
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,148.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,477.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$1,790.25
|
| Rate for Payer: Networks By Design Commercial |
$1,551.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
905355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$781.74 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: Adventist Health Commercial |
$978.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,312.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,790.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,401.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.05
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Cash Price |
$1,312.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,909.60
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,028.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,028.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Senior |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,148.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$894.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,193.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,477.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,670.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,670.90
|
| Rate for Payer: Multiplan Commercial |
$1,790.25
|
| Rate for Payer: Networks By Design Commercial |
$1,193.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: Riverside University Health System MISP |
$954.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,432.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.84
|
| Rate for Payer: United Healthcare All Other HMO |
$871.97
|
| Rate for Payer: United Healthcare HMO Rider |
$853.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$781.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,028.95
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
IP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
915355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$859.80 |
| Max. Negotiated Rate |
$3,869.10 |
| Rate for Payer: Adventist Health Commercial |
$859.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,323.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,166.70
|
| Rate for Payer: Cash Price |
$2,364.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,439.20
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,869.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,867.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,637.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,661.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.80
|
| Rate for Payer: Multiplan Commercial |
$3,224.25
|
| Rate for Payer: Networks By Design Commercial |
$2,794.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,613.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,536.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,407.92
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
OP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
915355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$594.23 |
| Max. Negotiated Rate |
$3,869.10 |
| Rate for Payer: Adventist Health Commercial |
$1,762.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,364.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,224.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,524.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,323.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,166.70
|
| Rate for Payer: Cash Price |
$2,364.45
|
| Rate for Payer: Cash Price |
$2,364.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,439.20
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,654.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,654.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,869.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$594.23
|
| Rate for Payer: InnovAge PACE Commercial |
$2,149.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,867.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,661.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,009.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,009.30
|
| Rate for Payer: Multiplan Commercial |
$3,224.25
|
| Rate for Payer: Networks By Design Commercial |
$2,149.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,719.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,579.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,579.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,613.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.42
|
| Rate for Payer: United Healthcare HMO Rider |
$1,536.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,407.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,654.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,654.15
|
|
