|
HC AK ADD EXOSKEL VARIABLE FRICTN
|
Facility
|
OP
|
$633.00
|
|
|
Service Code
|
CPT L5714
|
| Hospital Charge Code |
905355714
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$221.55 |
| Max. Negotiated Rate |
$569.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$538.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$348.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$306.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$373.98
|
| Rate for Payer: Blue Distinction Transplant |
$379.80
|
| Rate for Payer: Blue Shield of California Commercial |
$474.75
|
| Rate for Payer: Blue Shield of California EPN |
$344.35
|
| Rate for Payer: Cash Price |
$284.85
|
| 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: Dignity Health Commercial/Exchange |
$538.05
|
| Rate for Payer: Dignity Health Media |
$538.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$538.05
|
| 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: Health Plan of Nevada (Sierra) Other |
$474.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$221.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.53
|
| Rate for Payer: Multiplan Commercial |
$474.75
|
| Rate for Payer: Networks By Design Commercial |
$316.50
|
| Rate for Payer: Prime Health Services Commercial |
$538.05
|
| Rate for Payer: Riverside University Health System MISP |
$253.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$379.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.50
|
| Rate for Payer: United Healthcare All Other HMO |
$316.50
|
| Rate for Payer: United Healthcare HMO Rider |
$316.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$316.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$538.05
|
| Rate for Payer: Vantage Medical Group Senior |
$538.05
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
IP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
905355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,351.00 |
| Max. Negotiated Rate |
$6,079.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,607.17
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,404.00
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,079.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,505.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,573.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$5,066.25
|
| Rate for Payer: Networks By Design Commercial |
$3,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,550.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,491.24
|
| Rate for Payer: United Healthcare HMO Rider |
$2,437.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,229.15
|
|
|
HC AK ADD EXOSK EXT JTS FLUID CNT
|
Facility
|
OP
|
$6,755.00
|
|
|
Service Code
|
CPT L5726
|
| Hospital Charge Code |
905355726
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,364.25 |
| Max. Negotiated Rate |
$6,079.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,715.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,715.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,270.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,990.85
|
| Rate for Payer: Blue Distinction Transplant |
$4,053.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,066.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,674.72
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Cash Price |
$3,039.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,404.00
|
| Rate for Payer: Cigna of CA HMO |
$4,728.50
|
| Rate for Payer: Cigna of CA PPO |
$4,728.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,741.75
|
| Rate for Payer: Dignity Health Media |
$5,741.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,741.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,702.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,702.00
|
| Rate for Payer: Galaxy Health WC |
$5,741.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,053.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,079.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,066.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,364.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,505.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,404.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,769.55
|
| Rate for Payer: Multiplan Commercial |
$5,066.25
|
| Rate for Payer: Networks By Design Commercial |
$3,377.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,741.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,702.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,377.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,377.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,377.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,377.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,741.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,741.75
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
IP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
905355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,238.80 |
| Max. Negotiated Rate |
$5,574.60 |
| Rate for Payer: Blue Shield of California EPN |
$3,307.60
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,955.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,574.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,359.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,238.80
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: Networks By Design Commercial |
$3,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,338.85
|
| Rate for Payer: United Healthcare All Other HMO |
$2,284.35
|
| Rate for Payer: United Healthcare HMO Rider |
$2,234.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,044.02
|
|
|
HC AK ADD EXOSK FLUID SWING CONTL
|
Facility
|
OP
|
$6,194.00
|
|
|
Service Code
|
CPT L5724
|
| Hospital Charge Code |
905355724
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.78 |
| Max. Negotiated Rate |
$5,574.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,406.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,406.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,999.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,659.42
|
| Rate for Payer: Blue Distinction Transplant |
$3,716.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,645.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,369.54
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Cash Price |
$2,787.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,955.20
|
| Rate for Payer: Cigna of CA HMO |
$4,335.80
|
| Rate for Payer: Cigna of CA PPO |
$4,335.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,264.90
|
| Rate for Payer: Dignity Health Media |
$5,264.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,264.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,477.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,477.60
|
| Rate for Payer: Galaxy Health WC |
$5,264.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,716.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,574.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,645.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,167.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,379.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.54
|
| Rate for Payer: Multiplan Commercial |
$4,645.50
|
| Rate for Payer: Networks By Design Commercial |
$3,097.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,264.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,477.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,716.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,716.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,097.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,097.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,097.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,097.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,264.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,264.90
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
OP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
905355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$835.45 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,312.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,312.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,155.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.24
|
| Rate for Payer: Blue Distinction Transplant |
$1,432.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,790.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,298.53
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,909.60
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,028.95
|
| Rate for Payer: Dignity Health Media |
$2,028.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,028.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,148.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,790.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$835.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$988.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.67
|
| Rate for Payer: Multiplan Commercial |
$1,790.25
|
| Rate for Payer: Networks By Design Commercial |
$1,193.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: Riverside University Health System MISP |
$954.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,432.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,432.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,193.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,193.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,193.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,193.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,028.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,028.95
|
|
|
HC AK ADD EXOSK MECHANICAL STANCE
|
Facility
|
IP
|
$2,387.00
|
|
|
Service Code
|
CPT L5716
|
| Hospital Charge Code |
905355716
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$477.40 |
| Max. Negotiated Rate |
$2,148.30 |
| Rate for Payer: Blue Shield of California EPN |
$1,274.66
|
| Rate for Payer: Cash Price |
$1,074.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,909.60
|
| Rate for Payer: Cigna of CA HMO |
$1,670.90
|
| Rate for Payer: Cigna of CA PPO |
$1,670.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$954.80
|
| Rate for Payer: Galaxy Health WC |
$2,028.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,432.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,148.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,592.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$909.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.40
|
| Rate for Payer: Multiplan Commercial |
$1,790.25
|
| Rate for Payer: Networks By Design Commercial |
$1,193.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,028.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$901.33
|
| Rate for Payer: United Healthcare All Other HMO |
$880.33
|
| Rate for Payer: United Healthcare HMO Rider |
$861.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$787.71
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
IP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
905355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$859.80 |
| Max. Negotiated Rate |
$3,869.10 |
| Rate for Payer: Blue Shield of California EPN |
$2,295.67
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,439.20
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,869.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,867.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,637.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.80
|
| Rate for Payer: Multiplan Commercial |
$3,224.25
|
| Rate for Payer: Networks By Design Commercial |
$2,149.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,623.30
|
| Rate for Payer: United Healthcare All Other HMO |
$1,585.47
|
| Rate for Payer: United Healthcare HMO Rider |
$1,551.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,418.67
|
|
|
HC AK ADD EXOSK PHEU/HYDRAPNEU
|
Facility
|
OP
|
$4,299.00
|
|
|
Service Code
|
CPT L5780
|
| Hospital Charge Code |
905355780
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$656.41 |
| Max. Negotiated Rate |
$3,869.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,364.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,364.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,081.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,539.85
|
| Rate for Payer: Blue Distinction Transplant |
$2,579.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,224.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,338.66
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Cash Price |
$1,934.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,439.20
|
| Rate for Payer: Cigna of CA HMO |
$3,009.30
|
| Rate for Payer: Cigna of CA PPO |
$3,009.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,654.15
|
| Rate for Payer: Dignity Health Media |
$3,654.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,654.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,719.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,719.60
|
| Rate for Payer: Galaxy Health WC |
$3,654.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,579.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,869.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,224.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,504.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,867.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.59
|
| Rate for Payer: Multiplan Commercial |
$3,224.25
|
| Rate for Payer: Networks By Design Commercial |
$2,149.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,654.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,719.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,579.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,579.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,149.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,149.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,149.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,149.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,654.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,654.15
|
|
|
HC AK ADD EXOSK PNEUMATIC SWING
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT L5722
|
| Hospital Charge Code |
905355722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,702.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,603.60
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,402.40
|
| Rate for Payer: Cigna of CA HMO |
$2,102.10
|
| Rate for Payer: Cigna of CA PPO |
$2,102.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,702.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$2,252.25
|
| Rate for Payer: Networks By Design Commercial |
$1,501.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,133.93
|
| Rate for Payer: United Healthcare All Other HMO |
$1,107.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1,083.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$990.99
|
|
|
HC AK ADD EXOSK PNEUMATIC SWING
|
Facility
|
OP
|
$3,003.00
|
|
|
Service Code
|
CPT L5722
|
| Hospital Charge Code |
905355722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,051.05 |
| Max. Negotiated Rate |
$2,702.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,651.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,651.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,454.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,774.17
|
| Rate for Payer: Blue Distinction Transplant |
$1,801.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,252.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,633.63
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,402.40
|
| Rate for Payer: Cigna of CA HMO |
$2,102.10
|
| Rate for Payer: Cigna of CA PPO |
$2,102.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Dignity Health Media |
$2,552.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,552.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,702.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,252.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,051.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,322.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,231.23
|
| Rate for Payer: Multiplan Commercial |
$2,252.25
|
| Rate for Payer: Networks By Design Commercial |
$1,501.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,201.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,501.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,501.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,501.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,501.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,552.55
|
|
|
HC AK ADD EXOSK POLYCENTRIC FRICT
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT L5718
|
| Hospital Charge Code |
905355718
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$732.00 |
| Max. Negotiated Rate |
$3,294.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,954.44
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,928.00
|
| Rate for Payer: Cigna of CA HMO |
$2,562.00
|
| Rate for Payer: Cigna of CA PPO |
$2,562.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,464.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,464.00
|
| Rate for Payer: Galaxy Health WC |
$3,111.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,294.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,394.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$732.00
|
| Rate for Payer: Multiplan Commercial |
$2,745.00
|
| Rate for Payer: Networks By Design Commercial |
$1,830.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,382.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1,349.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,320.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,207.80
|
|
|
HC AK ADD EXOSK POLYCENTRIC FRICT
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT L5718
|
| Hospital Charge Code |
905355718
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,065.06 |
| Max. Negotiated Rate |
$3,294.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,013.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,013.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,772.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,162.33
|
| Rate for Payer: Blue Distinction Transplant |
$2,196.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,745.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,991.04
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Cash Price |
$1,647.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,928.00
|
| Rate for Payer: Cigna of CA HMO |
$2,562.00
|
| Rate for Payer: Cigna of CA PPO |
$2,562.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,111.00
|
| Rate for Payer: Dignity Health Media |
$3,111.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,111.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,464.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,464.00
|
| Rate for Payer: Galaxy Health WC |
$3,111.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,294.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,745.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,281.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,500.60
|
| Rate for Payer: Multiplan Commercial |
$2,745.00
|
| Rate for Payer: Networks By Design Commercial |
$1,830.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,464.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,830.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,830.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,830.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,111.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,111.00
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
OP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
905355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$745.50 |
| Max. Negotiated Rate |
$1,917.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,171.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,171.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,031.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,258.40
|
| Rate for Payer: Blue Distinction Transplant |
$1,278.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,597.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,158.72
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,704.00
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,810.50
|
| Rate for Payer: Dignity Health Media |
$1,810.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,810.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,917.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,597.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$745.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,420.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$894.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$873.30
|
| Rate for Payer: Multiplan Commercial |
$1,597.50
|
| Rate for Payer: Networks By Design Commercial |
$1,065.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: Riverside University Health System MISP |
$852.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,278.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,278.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,065.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,065.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,065.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,065.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,810.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,810.50
|
|
|
HC AK ADD FLEX INNER SKT EXT FRAM
|
Facility
|
IP
|
$2,130.00
|
|
|
Service Code
|
CPT L5651
|
| Hospital Charge Code |
905355651
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$426.00 |
| Max. Negotiated Rate |
$1,917.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,137.42
|
| Rate for Payer: Cash Price |
$958.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,704.00
|
| Rate for Payer: Cigna of CA HMO |
$1,491.00
|
| Rate for Payer: Cigna of CA PPO |
$1,491.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$852.00
|
| Rate for Payer: Galaxy Health WC |
$1,810.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,278.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,917.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,420.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$811.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.00
|
| Rate for Payer: Multiplan Commercial |
$1,597.50
|
| Rate for Payer: Networks By Design Commercial |
$1,065.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,810.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.29
|
| Rate for Payer: United Healthcare All Other HMO |
$785.54
|
| Rate for Payer: United Healthcare HMO Rider |
$768.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$702.90
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
OP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
905355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$569.10 |
| Max. Negotiated Rate |
$1,463.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$894.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$787.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$960.64
|
| Rate for Payer: Blue Distinction Transplant |
$975.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,219.50
|
| Rate for Payer: Blue Shield of California EPN |
$884.54
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.80
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,382.10
|
| Rate for Payer: Dignity Health Media |
$1,382.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,382.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,219.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$569.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,084.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$954.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$666.66
|
| Rate for Payer: Multiplan Commercial |
$1,219.50
|
| Rate for Payer: Networks By Design Commercial |
$813.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: Riverside University Health System MISP |
$650.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$813.00
|
| Rate for Payer: United Healthcare HMO Rider |
$813.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,382.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,382.10
|
|
|
HC AK ADD FLEX PROTCTV OUTER SURF
|
Facility
|
IP
|
$1,626.00
|
|
|
Service Code
|
CPT L5964
|
| Hospital Charge Code |
905355964
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$325.20 |
| Max. Negotiated Rate |
$1,463.40 |
| Rate for Payer: Blue Shield of California EPN |
$868.28
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,300.80
|
| Rate for Payer: Cigna of CA HMO |
$1,138.20
|
| Rate for Payer: Cigna of CA PPO |
$1,138.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$650.40
|
| Rate for Payer: Galaxy Health WC |
$1,382.10
|
| Rate for Payer: Global Benefits Group Commercial |
$975.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,463.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,084.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.20
|
| Rate for Payer: Multiplan Commercial |
$1,219.50
|
| Rate for Payer: Networks By Design Commercial |
$813.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,382.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$613.98
|
| Rate for Payer: United Healthcare All Other HMO |
$599.67
|
| Rate for Payer: United Healthcare HMO Rider |
$586.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$536.58
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
OP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
905355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,206.50 |
| Max. Negotiated Rate |
$8,522.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,207.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,207.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,584.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,594.29
|
| Rate for Payer: Blue Distinction Transplant |
$5,681.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,101.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,151.14
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,575.20
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,048.65
|
| Rate for Payer: Dignity Health Media |
$8,048.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,522.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,101.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,314.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,315.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,882.29
|
| Rate for Payer: Multiplan Commercial |
$7,101.75
|
| Rate for Payer: Networks By Design Commercial |
$4,734.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,787.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,681.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,681.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,734.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,734.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,734.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,734.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.65
|
| Rate for Payer: Vantage Medical Group Senior |
$8,048.65
|
|
|
HC AK ADD FLUID SWING & STANCE
|
Facility
|
IP
|
$9,469.00
|
|
|
Service Code
|
CPT L5828
|
| Hospital Charge Code |
905355828
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,893.80 |
| Max. Negotiated Rate |
$8,522.10 |
| Rate for Payer: Blue Shield of California EPN |
$5,056.45
|
| Rate for Payer: Cash Price |
$4,261.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,575.20
|
| Rate for Payer: Cigna of CA HMO |
$6,628.30
|
| Rate for Payer: Cigna of CA PPO |
$6,628.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,787.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,787.60
|
| Rate for Payer: Galaxy Health WC |
$8,048.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,681.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,522.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,315.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,607.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,893.80
|
| Rate for Payer: Multiplan Commercial |
$7,101.75
|
| Rate for Payer: Networks By Design Commercial |
$4,734.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,048.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,575.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3,492.17
|
| Rate for Payer: United Healthcare HMO Rider |
$3,416.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,124.77
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
IP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
905355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$658.40 |
| Max. Negotiated Rate |
$2,962.80 |
| Rate for Payer: Blue Shield of California EPN |
$1,757.93
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,633.60
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,962.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,195.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,254.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$658.40
|
| Rate for Payer: Multiplan Commercial |
$2,469.00
|
| Rate for Payer: Networks By Design Commercial |
$1,646.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,243.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1,214.09
|
| Rate for Payer: United Healthcare HMO Rider |
$1,187.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,086.36
|
|
|
HC AK ADD ISCHIAL CONTNMT/NRRW ML
|
Facility
|
OP
|
$3,292.00
|
|
|
Service Code
|
CPT L5649
|
| Hospital Charge Code |
905355649
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,152.20 |
| Max. Negotiated Rate |
$2,962.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,810.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,810.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,593.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,944.91
|
| Rate for Payer: Blue Distinction Transplant |
$1,975.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,469.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,790.85
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Cash Price |
$1,481.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,633.60
|
| Rate for Payer: Cigna of CA HMO |
$2,304.40
|
| Rate for Payer: Cigna of CA PPO |
$2,304.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,798.20
|
| Rate for Payer: Dignity Health Media |
$2,798.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,798.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,316.80
|
| Rate for Payer: Galaxy Health WC |
$2,798.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,975.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,962.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,469.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,152.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,195.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,349.72
|
| Rate for Payer: Multiplan Commercial |
$2,469.00
|
| Rate for Payer: Networks By Design Commercial |
$1,646.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,798.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,975.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,975.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,646.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,646.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,646.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,646.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,798.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,798.20
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
IP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.80 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Blue Shield of California EPN |
$458.71
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.80
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.36
|
| Rate for Payer: United Healthcare All Other HMO |
$316.80
|
| Rate for Payer: United Healthcare HMO Rider |
$309.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.47
|
|
|
HC AK ADDITION ACRYLIC SOCKET
|
Facility
|
OP
|
$859.00
|
|
|
Service Code
|
CPT L5631
|
| Hospital Charge Code |
905355631
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$300.65 |
| Max. Negotiated Rate |
$773.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$730.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$472.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$472.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$415.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$507.50
|
| Rate for Payer: Blue Distinction Transplant |
$515.40
|
| Rate for Payer: Blue Shield of California Commercial |
$644.25
|
| Rate for Payer: Blue Shield of California EPN |
$467.30
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Cash Price |
$386.55
|
| Rate for Payer: Central Health Plan Commercial |
$687.20
|
| Rate for Payer: Cigna of CA HMO |
$601.30
|
| Rate for Payer: Cigna of CA PPO |
$601.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$730.15
|
| Rate for Payer: Dignity Health Media |
$730.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$730.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$343.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$343.60
|
| Rate for Payer: Galaxy Health WC |
$730.15
|
| Rate for Payer: Global Benefits Group Commercial |
$515.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$773.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$644.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$300.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$572.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.19
|
| Rate for Payer: Multiplan Commercial |
$644.25
|
| Rate for Payer: Networks By Design Commercial |
$429.50
|
| Rate for Payer: Prime Health Services Commercial |
$730.15
|
| Rate for Payer: Riverside University Health System MISP |
$343.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$515.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$515.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$429.50
|
| Rate for Payer: United Healthcare All Other HMO |
$429.50
|
| Rate for Payer: United Healthcare HMO Rider |
$429.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$730.15
|
| Rate for Payer: Vantage Medical Group Senior |
$730.15
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.50 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$694.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$694.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$611.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$746.18
|
| Rate for Payer: Blue Distinction Transplant |
$757.80
|
| Rate for Payer: Blue Shield of California Commercial |
$947.25
|
| Rate for Payer: Blue Shield of California EPN |
$687.07
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,073.55
|
| Rate for Payer: Dignity Health Media |
$1,073.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,073.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$947.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$442.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.83
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Riverside University Health System MISP |
$505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.50
|
| Rate for Payer: United Healthcare All Other HMO |
$631.50
|
| Rate for Payer: United Healthcare HMO Rider |
$631.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$631.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,073.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,073.55
|
|
|
HC AK ADDITION AIR CUSHION SOCKET
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT L5648
|
| Hospital Charge Code |
905355648
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$252.60 |
| Max. Negotiated Rate |
$1,136.70 |
| Rate for Payer: Blue Shield of California EPN |
$674.44
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,010.40
|
| Rate for Payer: Cigna of CA HMO |
$884.10
|
| Rate for Payer: Cigna of CA PPO |
$884.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,136.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.60
|
| Rate for Payer: Multiplan Commercial |
$947.25
|
| Rate for Payer: Networks By Design Commercial |
$631.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.91
|
| Rate for Payer: United Healthcare All Other HMO |
$465.79
|
| Rate for Payer: United Healthcare HMO Rider |
$455.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$416.79
|
|
