|
HC BIVONA PED TRACH UNCUFFED 5.0
|
Facility
|
OP
|
$375.26
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$337.73 |
| Rate for Payer: Adventist Health Commercial |
$75.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$206.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$220.39
|
| Rate for Payer: Blue Shield of California Commercial |
$229.28
|
| Rate for Payer: Blue Shield of California EPN |
$149.73
|
| Rate for Payer: Cash Price |
$206.39
|
| Rate for Payer: Central Health Plan Commercial |
$300.21
|
| Rate for Payer: Cigna of CA HMO |
$240.17
|
| Rate for Payer: Cigna of CA PPO |
$277.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$318.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$318.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$318.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.10
|
| Rate for Payer: EPIC Health Plan Senior |
$150.10
|
| Rate for Payer: Galaxy Health WC |
$318.97
|
| Rate for Payer: Global Benefits Group Commercial |
$225.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$337.73
|
| Rate for Payer: InnovAge PACE Commercial |
$187.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$250.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$262.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$262.68
|
| Rate for Payer: Multiplan Commercial |
$281.44
|
| Rate for Payer: Networks By Design Commercial |
$243.92
|
| Rate for Payer: Prime Health Services Commercial |
$318.97
|
| Rate for Payer: Riverside University Health System MISP |
$150.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$225.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.63
|
| Rate for Payer: United Healthcare All Other HMO |
$187.63
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$318.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$318.97
|
| Rate for Payer: Vantage Medical Group Senior |
$318.97
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
IP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Cash Price |
$198.23
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$223.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
|
|
HC BIVONA PED TRACH UNCUFFED 5.5
|
Facility
|
OP
|
$360.41
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.08 |
| Max. Negotiated Rate |
$324.37 |
| Rate for Payer: Adventist Health Commercial |
$72.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$270.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$174.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$211.67
|
| Rate for Payer: Blue Shield of California Commercial |
$220.21
|
| Rate for Payer: Blue Shield of California EPN |
$143.80
|
| Rate for Payer: Cash Price |
$198.23
|
| Rate for Payer: Central Health Plan Commercial |
$288.33
|
| Rate for Payer: Cigna of CA HMO |
$230.66
|
| Rate for Payer: Cigna of CA PPO |
$266.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.16
|
| Rate for Payer: EPIC Health Plan Senior |
$144.16
|
| Rate for Payer: Galaxy Health WC |
$306.35
|
| Rate for Payer: Global Benefits Group Commercial |
$216.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$324.37
|
| Rate for Payer: InnovAge PACE Commercial |
$180.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$223.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$252.29
|
| Rate for Payer: Multiplan Commercial |
$270.31
|
| Rate for Payer: Networks By Design Commercial |
$234.27
|
| Rate for Payer: Prime Health Services Commercial |
$306.35
|
| Rate for Payer: Riverside University Health System MISP |
$144.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$216.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.21
|
| Rate for Payer: United Healthcare All Other HMO |
$180.21
|
| Rate for Payer: United Healthcare HMO Rider |
$180.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$180.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.35
|
| Rate for Payer: Vantage Medical Group Senior |
$306.35
|
|
|
HC BK ADD ENDOSK ALIGNABLE SYSTEM
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT L5910
|
| Hospital Charge Code |
905355910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.13 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$271.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$389.38
|
| Rate for Payer: Blue Shield of California Commercial |
$512.50
|
| Rate for Payer: Blue Shield of California EPN |
$334.15
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: Cigna of CA HMO |
$464.10
|
| Rate for Payer: Cigna of CA PPO |
$464.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$563.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$563.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$563.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$277.25
|
| Rate for Payer: InnovAge PACE Commercial |
$331.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$464.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$464.10
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: Riverside University Health System MISP |
$265.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.82
|
| Rate for Payer: United Healthcare All Other HMO |
$242.19
|
| Rate for Payer: United Healthcare HMO Rider |
$236.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$563.55
|
| Rate for Payer: Vantage Medical Group Senior |
$563.55
|
|
|
HC BK ADD ENDOSK ALIGNABLE SYSTEM
|
Facility
|
OP
|
$663.00
|
|
|
Service Code
|
CPT L5910
|
| Hospital Charge Code |
915355910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$217.13 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$271.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$389.38
|
| Rate for Payer: Blue Shield of California Commercial |
$512.50
|
| Rate for Payer: Blue Shield of California EPN |
$334.15
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: Cigna of CA HMO |
$464.10
|
| Rate for Payer: Cigna of CA PPO |
$464.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$563.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$563.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$563.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$277.25
|
| Rate for Payer: InnovAge PACE Commercial |
$331.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$464.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$464.10
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: Riverside University Health System MISP |
$265.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.82
|
| Rate for Payer: United Healthcare All Other HMO |
$242.19
|
| Rate for Payer: United Healthcare HMO Rider |
$236.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$563.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$563.55
|
| Rate for Payer: Vantage Medical Group Senior |
$563.55
|
|
|
HC BK ADD ENDOSK ALIGNABLE SYSTEM
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT L5910
|
| Hospital Charge Code |
915355910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$512.50
|
| Rate for Payer: Blue Shield of California EPN |
$334.15
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: Cigna of CA HMO |
$464.10
|
| Rate for Payer: Cigna of CA PPO |
$464.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.60
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.82
|
| Rate for Payer: United Healthcare All Other HMO |
$242.19
|
| Rate for Payer: United Healthcare HMO Rider |
$236.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.13
|
|
|
HC BK ADD ENDOSK ALIGNABLE SYSTEM
|
Facility
|
IP
|
$663.00
|
|
|
Service Code
|
CPT L5910
|
| Hospital Charge Code |
905355910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Adventist Health Commercial |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$512.50
|
| Rate for Payer: Blue Shield of California EPN |
$334.15
|
| Rate for Payer: Cash Price |
$364.65
|
| Rate for Payer: Central Health Plan Commercial |
$530.40
|
| Rate for Payer: Cigna of CA HMO |
$464.10
|
| Rate for Payer: Cigna of CA PPO |
$464.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.20
|
| Rate for Payer: EPIC Health Plan Senior |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$563.55
|
| Rate for Payer: Global Benefits Group Commercial |
$397.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$596.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$442.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$410.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.60
|
| Rate for Payer: Multiplan Commercial |
$497.25
|
| Rate for Payer: Networks By Design Commercial |
$430.95
|
| Rate for Payer: Prime Health Services Commercial |
$563.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.82
|
| Rate for Payer: United Healthcare All Other HMO |
$242.19
|
| Rate for Payer: United Healthcare HMO Rider |
$236.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.13
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
905355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$525.97 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Adventist Health Commercial |
$658.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$943.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.44
|
| Rate for Payer: Blue Shield of California EPN |
$809.42
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$534.73
|
| Rate for Payer: InnovAge PACE Commercial |
$803.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Riverside University Health System MISP |
$642.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
915355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.44
|
| Rate for Payer: Blue Shield of California EPN |
$809.42
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
905355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.44
|
| Rate for Payer: Blue Shield of California EPN |
$809.42
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
|
|
HC BK ADD ENDOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT L5940
|
| Hospital Charge Code |
915355940
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$525.97 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Adventist Health Commercial |
$658.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$943.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,241.44
|
| Rate for Payer: Blue Shield of California EPN |
$809.42
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,124.20
|
| Rate for Payer: Cigna of CA PPO |
$1,124.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$534.73
|
| Rate for Payer: InnovAge PACE Commercial |
$803.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$803.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Riverside University Health System MISP |
$642.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.73
|
| Rate for Payer: United Healthcare All Other HMO |
$586.67
|
| Rate for Payer: United Healthcare HMO Rider |
$573.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
915355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$546.32 |
| Max. Negotiated Rate |
$1,665.90 |
| Rate for Payer: Adventist Health Commercial |
$758.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,018.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,388.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.82
|
| Rate for Payer: Blue Shield of California EPN |
$932.90
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,573.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,573.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$546.32
|
| Rate for Payer: InnovAge PACE Commercial |
$925.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,295.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,295.70
|
| Rate for Payer: Multiplan Commercial |
$1,388.25
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: Riverside University Health System MISP |
$740.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,573.35
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
905355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$546.32 |
| Max. Negotiated Rate |
$1,665.90 |
| Rate for Payer: Adventist Health Commercial |
$758.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,018.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,388.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.82
|
| Rate for Payer: Blue Shield of California EPN |
$932.90
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,573.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,573.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$546.32
|
| Rate for Payer: InnovAge PACE Commercial |
$925.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,295.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,295.70
|
| Rate for Payer: Multiplan Commercial |
$1,388.25
|
| Rate for Payer: Networks By Design Commercial |
$925.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: Riverside University Health System MISP |
$740.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,573.35
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
905355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$1,665.90 |
| Rate for Payer: Adventist Health Commercial |
$370.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.82
|
| Rate for Payer: Blue Shield of California EPN |
$932.90
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.20
|
| Rate for Payer: Multiplan Commercial |
$1,388.25
|
| Rate for Payer: Networks By Design Commercial |
$1,203.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
|
|
HC BK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
CPT L5785
|
| Hospital Charge Code |
915355785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$1,665.90 |
| Rate for Payer: Adventist Health Commercial |
$370.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,430.82
|
| Rate for Payer: Blue Shield of California EPN |
$932.90
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,480.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.70
|
| Rate for Payer: Cigna of CA PPO |
$1,295.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,665.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.20
|
| Rate for Payer: Multiplan Commercial |
$1,388.25
|
| Rate for Payer: Networks By Design Commercial |
$1,203.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.68
|
| Rate for Payer: United Healthcare All Other HMO |
$676.17
|
| Rate for Payer: United Healthcare HMO Rider |
$661.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.20
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
905355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Blue Shield of California Commercial |
$813.20
|
| Rate for Payer: Blue Shield of California EPN |
$530.21
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
905355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.53 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$431.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.84
|
| Rate for Payer: Blue Shield of California Commercial |
$813.20
|
| Rate for Payer: Blue Shield of California EPN |
$530.21
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$381.22
|
| Rate for Payer: InnovAge PACE Commercial |
$526.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
915355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Blue Shield of California Commercial |
$813.20
|
| Rate for Payer: Blue Shield of California EPN |
$530.21
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
|
|
HC BK ADD EXOSKEL SINGLE AXIS MAN
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT L5710
|
| Hospital Charge Code |
915355710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$344.53 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$431.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.84
|
| Rate for Payer: Blue Shield of California Commercial |
$813.20
|
| Rate for Payer: Blue Shield of California EPN |
$530.21
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Cash Price |
$578.60
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$736.40
|
| Rate for Payer: Cigna of CA PPO |
$736.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$381.22
|
| Rate for Payer: InnovAge PACE Commercial |
$526.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$526.00
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.82
|
| Rate for Payer: United Healthcare All Other HMO |
$384.30
|
| Rate for Payer: United Healthcare HMO Rider |
$375.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
905355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$508.28 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Adventist Health Commercial |
$636.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,164.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$911.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,199.70
|
| Rate for Payer: Blue Shield of California EPN |
$782.21
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,319.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,396.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$734.94
|
| Rate for Payer: InnovAge PACE Commercial |
$776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$811.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,086.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,086.40
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: Riverside University Health System MISP |
$620.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,319.20
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
915355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Adventist Health Commercial |
$310.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,199.70
|
| Rate for Payer: Blue Shield of California EPN |
$782.21
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,396.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.40
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$1,008.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
905355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Adventist Health Commercial |
$310.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,199.70
|
| Rate for Payer: Blue Shield of California EPN |
$782.21
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,396.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$310.40
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$1,008.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
|
|
HC BK ADD FLEX INNR SKT EXT FRAME
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT L5645
|
| Hospital Charge Code |
915355645
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$508.28 |
| Max. Negotiated Rate |
$1,396.80 |
| Rate for Payer: Adventist Health Commercial |
$636.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$853.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,164.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$911.49
|
| Rate for Payer: Blue Shield of California Commercial |
$1,199.70
|
| Rate for Payer: Blue Shield of California EPN |
$782.21
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,241.60
|
| Rate for Payer: Cigna of CA HMO |
$1,086.40
|
| Rate for Payer: Cigna of CA PPO |
$1,086.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,319.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Senior |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,396.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$734.94
|
| Rate for Payer: InnovAge PACE Commercial |
$776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$811.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$960.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$636.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,086.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,086.40
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$776.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: Riverside University Health System MISP |
$620.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$931.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$582.47
|
| Rate for Payer: United Healthcare All Other HMO |
$566.95
|
| Rate for Payer: United Healthcare HMO Rider |
$554.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$508.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,319.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,319.20
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
905355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,040.46
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Cash Price |
$740.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$833.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$874.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
|
|
HC BK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5962
|
| Hospital Charge Code |
915355962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,040.46
|
| Rate for Payer: Blue Shield of California EPN |
$678.38
|
| Rate for Payer: Cash Price |
$740.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$833.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$874.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.15
|
| Rate for Payer: United Healthcare All Other HMO |
$491.69
|
| Rate for Payer: United Healthcare HMO Rider |
$481.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.81
|
|
