|
HC AIRWAY MASK LMA CUFF PILOT #3
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698541
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.76
|
| Rate for Payer: Blue Distinction Transplant |
$31.24
|
| Rate for Payer: Blue Shield of California Commercial |
$32.75
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Media |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Riverside University Health System MISP |
$20.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #3
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698541
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #4
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698542
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.76
|
| Rate for Payer: Blue Distinction Transplant |
$31.24
|
| Rate for Payer: Blue Shield of California Commercial |
$32.75
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Media |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Riverside University Health System MISP |
$20.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #4
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698542
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #5
|
Facility
|
OP
|
$52.07
|
|
| Hospital Charge Code |
901698543
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.76
|
| Rate for Payer: Blue Distinction Transplant |
$31.24
|
| Rate for Payer: Blue Shield of California Commercial |
$32.75
|
| Rate for Payer: Blue Shield of California EPN |
$25.46
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Media |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Riverside University Health System MISP |
$20.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC AIRWAY MASK LMA CUFF PILOT #5
|
Facility
|
IP
|
$52.07
|
|
| Hospital Charge Code |
901698543
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC AIRWAY ORAL GUEDEL 40MM
|
Facility
|
OP
|
$8.77
|
|
| Hospital Charge Code |
913200776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.18
|
| Rate for Payer: Blue Distinction Transplant |
$5.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$6.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.45
|
| Rate for Payer: Dignity Health Media |
$7.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
| Rate for Payer: Riverside University Health System MISP |
$3.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7.45
|
|
|
HC AIRWAY ORAL GUEDEL 40MM
|
Facility
|
IP
|
$8.77
|
|
| Hospital Charge Code |
913200776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
IP
|
$6,545.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,309.00 |
| Max. Negotiated Rate |
$5,890.50 |
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,236.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,618.00
|
| Rate for Payer: Galaxy Health WC |
$5,563.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,927.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,890.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,493.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.00
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
| Rate for Payer: Networks By Design Commercial |
$4,254.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,563.25
|
|
|
HC AIRWAY TRACH/BRONCH REVIS STNT
|
Facility
|
OP
|
$6,545.00
|
|
|
Service Code
|
CPT 31638
|
| Hospital Charge Code |
900803519
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$300.37 |
| Max. Negotiated Rate |
$14,109.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,551.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,551.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,927.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,116.80
|
| Rate for Payer: Blue Shield of California EPN |
$3,200.50
|
| Rate for Payer: Caremore Medicare Advantage |
$8,551.50
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Cash Price |
$2,945.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,236.00
|
| Rate for Payer: Cigna of CA HMO |
$4,188.80
|
| Rate for Payer: Cigna of CA PPO |
$4,843.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Dignity Health Media |
$8,551.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,406.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,544.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,551.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,551.50
|
| Rate for Payer: Galaxy Health WC |
$5,563.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,927.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,890.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,908.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,024.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,109.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,551.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12,827.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,365.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,551.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,309.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,459.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,459.01
|
| Rate for Payer: Multiplan Commercial |
$4,908.75
|
| Rate for Payer: Networks By Design Commercial |
$4,254.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,563.25
|
| Rate for Payer: Prime Health Services Medicare |
$9,064.59
|
| Rate for Payer: Riverside University Health System MISP |
$9,406.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,927.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,927.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,272.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,272.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,272.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,272.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,827.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,406.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,551.50
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
OP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
905355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,618.05 |
| Max. Negotiated Rate |
$4,160.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,542.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,542.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,238.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,731.27
|
| Rate for Payer: Blue Distinction Transplant |
$2,773.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,467.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,514.91
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,698.40
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,929.55
|
| Rate for Payer: Dignity Health Media |
$3,929.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,929.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,160.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,467.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,618.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,083.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,895.43
|
| Rate for Payer: Multiplan Commercial |
$3,467.25
|
| Rate for Payer: Networks By Design Commercial |
$2,311.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,849.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,773.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,773.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,311.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,311.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,311.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,311.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,929.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,929.55
|
|
|
HC AK ADD 4-BAR FRICTION SWING PH
|
Facility
|
IP
|
$4,623.00
|
|
|
Service Code
|
CPT L5611
|
| Hospital Charge Code |
905355611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$924.60 |
| Max. Negotiated Rate |
$4,160.70 |
| Rate for Payer: Blue Shield of California EPN |
$2,468.68
|
| Rate for Payer: Cash Price |
$2,080.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,698.40
|
| Rate for Payer: Cigna of CA HMO |
$3,236.10
|
| Rate for Payer: Cigna of CA PPO |
$3,236.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,849.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,849.20
|
| Rate for Payer: Galaxy Health WC |
$3,929.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,773.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,160.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,083.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,761.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$924.60
|
| Rate for Payer: Multiplan Commercial |
$3,467.25
|
| Rate for Payer: Networks By Design Commercial |
$2,311.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,929.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,745.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1,704.96
|
| Rate for Payer: United Healthcare HMO Rider |
$1,667.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,525.59
|
|
|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
IP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
905355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,810.80 |
| Max. Negotiated Rate |
$8,148.60 |
| Rate for Payer: Blue Shield of California EPN |
$4,834.84
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,243.20
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,148.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,449.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,810.80
|
| Rate for Payer: Multiplan Commercial |
$6,790.50
|
| Rate for Payer: Networks By Design Commercial |
$4,527.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,418.79
|
| Rate for Payer: United Healthcare All Other HMO |
$3,339.12
|
| Rate for Payer: United Healthcare HMO Rider |
$3,266.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,987.82
|
|
|
HC AK ADD 4-BAR HYDRAULIC SWG PHS
|
Facility
|
OP
|
$9,054.00
|
|
|
Service Code
|
CPT L5613
|
| Hospital Charge Code |
905355613
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,638.56 |
| Max. Negotiated Rate |
$8,148.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,979.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,979.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,383.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,349.10
|
| Rate for Payer: Blue Distinction Transplant |
$5,432.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,790.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,925.38
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Cash Price |
$4,074.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,243.20
|
| Rate for Payer: Cigna of CA HMO |
$6,337.80
|
| Rate for Payer: Cigna of CA PPO |
$6,337.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,695.90
|
| Rate for Payer: Dignity Health Media |
$7,695.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,695.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,621.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,621.60
|
| Rate for Payer: Galaxy Health WC |
$7,695.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,432.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,148.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,790.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,168.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,039.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,638.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,712.14
|
| Rate for Payer: Multiplan Commercial |
$6,790.50
|
| Rate for Payer: Networks By Design Commercial |
$4,527.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,695.90
|
| Rate for Payer: Riverside University Health System MISP |
$3,621.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,432.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,432.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,527.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,527.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,527.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,527.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,695.90
|
| Rate for Payer: Vantage Medical Group Senior |
$7,695.90
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
OP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
905355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,019.34 |
| Max. Negotiated Rate |
$11,856.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,245.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,245.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,378.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,783.20
|
| Rate for Payer: Blue Distinction Transplant |
$7,904.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9,880.50
|
| Rate for Payer: Blue Shield of California EPN |
$7,166.66
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,539.20
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,197.90
|
| Rate for Payer: Dignity Health Media |
$11,197.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,197.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,856.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,880.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,610.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,019.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,401.34
|
| Rate for Payer: Multiplan Commercial |
$9,880.50
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: Riverside University Health System MISP |
$5,269.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,904.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,904.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,587.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,587.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,197.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11,197.90
|
|
|
HC AK ADD 4-BAR PNEUMATIC SWG PHS
|
Facility
|
IP
|
$13,174.00
|
|
|
Service Code
|
CPT L5614
|
| Hospital Charge Code |
905355614
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,634.80 |
| Max. Negotiated Rate |
$11,856.60 |
| Rate for Payer: Blue Shield of California EPN |
$7,034.92
|
| Rate for Payer: Cash Price |
$5,928.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,539.20
|
| Rate for Payer: Cigna of CA HMO |
$9,221.80
|
| Rate for Payer: Cigna of CA PPO |
$9,221.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,269.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,269.60
|
| Rate for Payer: Galaxy Health WC |
$11,197.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,904.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,856.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,019.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,634.80
|
| Rate for Payer: Multiplan Commercial |
$9,880.50
|
| Rate for Payer: Networks By Design Commercial |
$6,587.00
|
| Rate for Payer: Prime Health Services Commercial |
$11,197.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,974.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,858.57
|
| Rate for Payer: United Healthcare HMO Rider |
$4,753.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,347.42
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
905355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$492.40 |
| Max. Negotiated Rate |
$2,215.80 |
| Rate for Payer: Blue Shield of California EPN |
$1,314.71
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,969.60
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,215.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,642.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$938.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.40
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$929.65
|
| Rate for Payer: United Healthcare All Other HMO |
$907.99
|
| Rate for Payer: United Healthcare HMO Rider |
$888.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$812.46
|
|
|
HC AK ADD ENTOSK ULTRALIGHT MATRL
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT L5950
|
| Hospital Charge Code |
905355950
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$861.70 |
| Max. Negotiated Rate |
$2,215.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,354.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,354.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,192.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,454.55
|
| Rate for Payer: Blue Distinction Transplant |
$1,477.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,846.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,339.33
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Cash Price |
$1,107.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,969.60
|
| Rate for Payer: Cigna of CA HMO |
$1,723.40
|
| Rate for Payer: Cigna of CA PPO |
$1,723.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,092.70
|
| Rate for Payer: Dignity Health Media |
$2,092.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,092.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$984.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$984.80
|
| Rate for Payer: Galaxy Health WC |
$2,092.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,215.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,846.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$861.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,642.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$862.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,009.42
|
| Rate for Payer: Multiplan Commercial |
$1,846.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,092.70
|
| Rate for Payer: Riverside University Health System MISP |
$984.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,477.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,477.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,231.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,231.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,231.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,092.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,092.70
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
905355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$351.20 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Blue Shield of California EPN |
$937.70
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$669.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.20
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$663.07
|
| Rate for Payer: United Healthcare All Other HMO |
$647.61
|
| Rate for Payer: United Healthcare HMO Rider |
$633.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$579.48
|
|
|
HC AK ADD EXOSKELETAL SAFETY KNEE
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT L5712
|
| Hospital Charge Code |
905355712
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$549.10 |
| Max. Negotiated Rate |
$1,580.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$965.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$850.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,037.44
|
| Rate for Payer: Blue Distinction Transplant |
$1,053.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,317.00
|
| Rate for Payer: Blue Shield of California EPN |
$955.26
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Cash Price |
$790.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,404.80
|
| Rate for Payer: Cigna of CA HMO |
$1,229.20
|
| Rate for Payer: Cigna of CA PPO |
$1,229.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,492.60
|
| Rate for Payer: Dignity Health Media |
$1,492.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,492.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$702.40
|
| Rate for Payer: Galaxy Health WC |
$1,492.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,580.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,317.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$614.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,171.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.96
|
| Rate for Payer: Multiplan Commercial |
$1,317.00
|
| Rate for Payer: Networks By Design Commercial |
$878.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,492.60
|
| Rate for Payer: Riverside University Health System MISP |
$702.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,053.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$878.00
|
| Rate for Payer: United Healthcare All Other HMO |
$878.00
|
| Rate for Payer: United Healthcare HMO Rider |
$878.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$878.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,492.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,492.60
|
|
|
HC AK ADD EXOSKELETAL ULTRALIGHT
|
Facility
|
OP
|
$5,279.00
|
|
|
Service Code
|
CPT L5790
|
| Hospital Charge Code |
905355790
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$794.14 |
| Max. Negotiated Rate |
$4,751.10 |
| 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 |
$2,903.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,556.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,118.83
|
| Rate for Payer: Blue Distinction Transplant |
$3,167.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,959.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,871.78
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,487.15
|
| Rate for Payer: Dignity Health Media |
$4,487.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,487.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3,959.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,847.65
|
| 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: LLUH Dept of Risk Management WC |
$2,164.39
|
| 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 |
$2,639.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,639.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,639.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,639.50
|
| 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: Blue Shield of California EPN |
$2,818.99
|
| Rate for Payer: Cash Price |
$2,375.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,223.20
|
| Rate for Payer: Cigna of CA HMO |
$3,695.30
|
| Rate for Payer: Cigna of CA PPO |
$3,695.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,111.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$1,055.80
|
| 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: United Healthcare All Other Commercial |
$1,993.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1,946.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,904.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,742.07
|
|
|
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 |
$354.20 |
| Max. Negotiated Rate |
$910.80 |
| 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 |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$597.89
|
| Rate for Payer: Blue Distinction Transplant |
$607.20
|
| Rate for Payer: Blue Shield of California Commercial |
$759.00
|
| Rate for Payer: Blue Shield of California EPN |
$550.53
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Media |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.20
|
| 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: LLUH Dept of Risk Management WC |
$414.92
|
| 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 |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| 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: Blue Shield of California EPN |
$540.41
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$202.40
|
| 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: United Healthcare All Other Commercial |
$382.13
|
| Rate for Payer: United Healthcare All Other HMO |
$373.23
|
| Rate for Payer: United Healthcare HMO Rider |
$365.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.96
|
|
|
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: Blue Shield of California EPN |
$338.02
|
| Rate for Payer: Cash Price |
$284.85
|
| Rate for Payer: Central Health Plan Commercial |
$506.40
|
| Rate for Payer: Cigna of CA HMO |
$443.10
|
| Rate for Payer: Cigna of CA PPO |
$443.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$126.60
|
| 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: United Healthcare All Other Commercial |
$239.02
|
| Rate for Payer: United Healthcare All Other HMO |
$233.45
|
| Rate for Payer: United Healthcare HMO Rider |
$228.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.89
|
|
