|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
OP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
905355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,137.99 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,160.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,160.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,423.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,616.96
|
| Rate for Payer: Blue Distinction Transplant |
$6,720.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,400.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,092.80
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,960.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,520.00
|
| Rate for Payer: Dignity Health Media |
$9,520.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,520.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,080.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,400.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,920.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,137.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,592.00
|
| Rate for Payer: Multiplan Commercial |
$8,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: Riverside University Health System MISP |
$4,480.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,720.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,720.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,600.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,600.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,600.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,600.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,520.00
|
| Rate for Payer: Vantage Medical Group Senior |
$9,520.00
|
|
|
HC AK ADDITION EXOSKELETAL SNS
|
Facility
|
IP
|
$11,200.00
|
|
|
Service Code
|
CPT L5728
|
| Hospital Charge Code |
905355728
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,240.00 |
| Max. Negotiated Rate |
$10,080.00 |
| Rate for Payer: Blue Shield of California EPN |
$5,980.80
|
| Rate for Payer: Cash Price |
$5,040.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,960.00
|
| Rate for Payer: Cigna of CA HMO |
$7,840.00
|
| Rate for Payer: Cigna of CA PPO |
$7,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,480.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,480.00
|
| Rate for Payer: Galaxy Health WC |
$9,520.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,720.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,470.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,267.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,240.00
|
| Rate for Payer: Multiplan Commercial |
$8,400.00
|
| Rate for Payer: Networks By Design Commercial |
$5,600.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,520.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,229.12
|
| Rate for Payer: United Healthcare All Other HMO |
$4,130.56
|
| Rate for Payer: United Healthcare HMO Rider |
$4,040.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,696.00
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
OP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
905355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,982.70 |
| Max. Negotiated Rate |
$7,669.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,687.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,687.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,126.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,034.80
|
| Rate for Payer: Blue Distinction Transplant |
$5,113.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,391.50
|
| Rate for Payer: Blue Shield of California EPN |
$4,635.97
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,817.60
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,243.70
|
| Rate for Payer: Dignity Health Media |
$7,243.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,669.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,391.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,982.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,987.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,494.02
|
| Rate for Payer: Multiplan Commercial |
$6,391.50
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: Riverside University Health System MISP |
$3,408.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,113.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,113.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,243.70
|
| Rate for Payer: Vantage Medical Group Senior |
$7,243.70
|
|
|
HC AK ADDITION HYDRACADENCE
|
Facility
|
IP
|
$8,522.00
|
|
|
Service Code
|
CPT L5610
|
| Hospital Charge Code |
905355610
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,704.40 |
| Max. Negotiated Rate |
$7,669.80 |
| Rate for Payer: Blue Shield of California EPN |
$4,550.75
|
| Rate for Payer: Cash Price |
$3,834.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,817.60
|
| Rate for Payer: Cigna of CA HMO |
$5,965.40
|
| Rate for Payer: Cigna of CA PPO |
$5,965.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,408.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,408.80
|
| Rate for Payer: Galaxy Health WC |
$7,243.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,113.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,669.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,684.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,246.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,704.40
|
| Rate for Payer: Multiplan Commercial |
$6,391.50
|
| Rate for Payer: Networks By Design Commercial |
$4,261.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,243.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,217.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3,142.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3,074.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,812.26
|
|
|
HC AK ADDITION LEATHER SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
905355642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$359.80
|
| Rate for Payer: Blue Distinction Transplant |
$365.40
|
| Rate for Payer: Blue Shield of California Commercial |
$456.75
|
| Rate for Payer: Blue Shield of California EPN |
$331.30
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$517.65
|
| Rate for Payer: Dignity Health Media |
$517.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$517.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$456.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$213.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.69
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: Riverside University Health System MISP |
$243.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$365.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$365.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$304.50
|
| Rate for Payer: United Healthcare All Other HMO |
$304.50
|
| Rate for Payer: United Healthcare HMO Rider |
$304.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$517.65
|
| Rate for Payer: Vantage Medical Group Senior |
$517.65
|
|
|
HC AK ADDITION LEATHER SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5642
|
| Hospital Charge Code |
905355642
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Blue Shield of California EPN |
$325.21
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.80
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.96
|
| Rate for Payer: United Healthcare All Other HMO |
$224.60
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.97
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
OP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
905355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,200.44 |
| Max. Negotiated Rate |
$3,278.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,003.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,003.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,763.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,152.28
|
| Rate for Payer: Blue Distinction Transplant |
$2,185.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,732.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,981.79
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,914.40
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,096.55
|
| Rate for Payer: Dignity Health Media |
$3,096.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,096.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,278.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,732.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,275.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,200.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,493.63
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,457.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,821.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,821.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,821.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,821.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,096.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,096.55
|
|
|
HC AK ADDITION MULTIPLEX SYSTEM
|
Facility
|
IP
|
$3,643.00
|
|
|
Service Code
|
CPT L5616
|
| Hospital Charge Code |
905355616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$728.60 |
| Max. Negotiated Rate |
$3,278.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,945.36
|
| Rate for Payer: Cash Price |
$1,639.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,914.40
|
| Rate for Payer: Cigna of CA HMO |
$2,550.10
|
| Rate for Payer: Cigna of CA PPO |
$2,550.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,457.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,457.20
|
| Rate for Payer: Galaxy Health WC |
$3,096.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,278.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.60
|
| Rate for Payer: Multiplan Commercial |
$2,732.25
|
| Rate for Payer: Networks By Design Commercial |
$1,821.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,096.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,375.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1,343.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,314.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,202.19
|
|
|
HC AK ADDITION PELVIC BAND
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT L5697
|
| Hospital Charge Code |
905355697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Blue Shield of California EPN |
$131.36
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$172.20
|
| Rate for Payer: Cigna of CA PPO |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$123.00
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.89
|
| Rate for Payer: United Healthcare All Other HMO |
$90.72
|
| Rate for Payer: United Healthcare HMO Rider |
$88.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.18
|
|
|
HC AK ADDITION PELVIC BAND
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT L5697
|
| Hospital Charge Code |
905355697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.34
|
| Rate for Payer: Blue Distinction Transplant |
$147.60
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$133.82
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$172.20
|
| Rate for Payer: Cigna of CA PPO |
$172.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Media |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$184.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$86.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$123.00
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC AK ADDITION PELVIC JOINT
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT L5696
|
| Hospital Charge Code |
905355696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.49 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$499.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$323.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$323.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$284.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.39
|
| Rate for Payer: Blue Distinction Transplant |
$352.80
|
| Rate for Payer: Blue Shield of California Commercial |
$441.00
|
| Rate for Payer: Blue Shield of California EPN |
$319.87
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Central Health Plan Commercial |
$470.40
|
| Rate for Payer: Cigna of CA HMO |
$411.60
|
| Rate for Payer: Cigna of CA PPO |
$411.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$499.80
|
| Rate for Payer: Dignity Health Media |
$499.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$235.20
|
| Rate for Payer: Galaxy Health WC |
$499.80
|
| Rate for Payer: Global Benefits Group Commercial |
$352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$529.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$441.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$205.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.08
|
| Rate for Payer: Multiplan Commercial |
$441.00
|
| Rate for Payer: Networks By Design Commercial |
$294.00
|
| Rate for Payer: Prime Health Services Commercial |
$499.80
|
| Rate for Payer: Riverside University Health System MISP |
$235.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$352.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$352.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$294.00
|
| Rate for Payer: United Healthcare All Other HMO |
$294.00
|
| Rate for Payer: United Healthcare HMO Rider |
$294.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$294.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.80
|
| Rate for Payer: Vantage Medical Group Senior |
$499.80
|
|
|
HC AK ADDITION PELVIC JOINT
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
CPT L5696
|
| Hospital Charge Code |
905355696
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$529.20 |
| Rate for Payer: Blue Shield of California EPN |
$313.99
|
| Rate for Payer: Cash Price |
$264.60
|
| Rate for Payer: Central Health Plan Commercial |
$470.40
|
| Rate for Payer: Cigna of CA HMO |
$411.60
|
| Rate for Payer: Cigna of CA PPO |
$411.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$235.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$235.20
|
| Rate for Payer: Galaxy Health WC |
$499.80
|
| Rate for Payer: Global Benefits Group Commercial |
$352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$392.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$441.00
|
| Rate for Payer: Networks By Design Commercial |
$294.00
|
| Rate for Payer: Prime Health Services Commercial |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.03
|
| Rate for Payer: United Healthcare All Other HMO |
$216.85
|
| Rate for Payer: United Healthcare HMO Rider |
$212.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$194.04
|
|
|
HC AK ADDITION SAFETY KNEE
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
905355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$747.06 |
| Max. Negotiated Rate |
$2,338.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,428.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,428.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,257.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,534.90
|
| Rate for Payer: Blue Distinction Transplant |
$1,558.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,948.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,413.31
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,078.40
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,208.30
|
| Rate for Payer: Dignity Health Media |
$2,208.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,338.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,948.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$909.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,732.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.18
|
| Rate for Payer: Multiplan Commercial |
$1,948.50
|
| Rate for Payer: Networks By Design Commercial |
$1,299.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,039.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,558.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,558.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,299.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,208.30
|
|
|
HC AK ADDITION SAFETY KNEE
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
CPT L5812
|
| Hospital Charge Code |
905355812
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$2,338.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,387.33
|
| Rate for Payer: Cash Price |
$1,169.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,078.40
|
| Rate for Payer: Cigna of CA HMO |
$1,818.60
|
| Rate for Payer: Cigna of CA PPO |
$1,818.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,039.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,039.20
|
| Rate for Payer: Galaxy Health WC |
$2,208.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,558.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,338.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,732.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$989.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.60
|
| Rate for Payer: Multiplan Commercial |
$1,948.50
|
| Rate for Payer: Networks By Design Commercial |
$1,299.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,208.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$981.00
|
| Rate for Payer: United Healthcare All Other HMO |
$958.14
|
| Rate for Payer: United Healthcare HMO Rider |
$937.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$857.34
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
905355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Blue Shield of California EPN |
$162.87
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.17
|
| Rate for Payer: United Healthcare All Other HMO |
$112.48
|
| Rate for Payer: United Healthcare HMO Rider |
$110.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.65
|
|
|
HC AK ADDITION SELISIAN BANDAGE
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L5698
|
| Hospital Charge Code |
905355698
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$93.37 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.19
|
| Rate for Payer: Blue Distinction Transplant |
$183.00
|
| Rate for Payer: Blue Shield of California Commercial |
$228.75
|
| Rate for Payer: Blue Shield of California EPN |
$165.92
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Media |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.50
|
| Rate for Payer: United Healthcare All Other HMO |
$152.50
|
| Rate for Payer: United Healthcare HMO Rider |
$152.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
OP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
905355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$484.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$426.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$519.90
|
| Rate for Payer: Blue Distinction Transplant |
$528.00
|
| Rate for Payer: Blue Shield of California Commercial |
$660.00
|
| Rate for Payer: Blue Shield of California EPN |
$478.72
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.00
|
| Rate for Payer: Dignity Health Media |
$748.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$660.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.80
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: Riverside University Health System MISP |
$352.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.00
|
| Rate for Payer: United Healthcare All Other HMO |
$440.00
|
| Rate for Payer: United Healthcare HMO Rider |
$440.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.00
|
| Rate for Payer: Vantage Medical Group Senior |
$748.00
|
|
|
HC AK ADDITION SUCTION SUSPENSION
|
Facility
|
IP
|
$880.00
|
|
|
Service Code
|
CPT L5652
|
| Hospital Charge Code |
905355652
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Blue Shield of California EPN |
$469.92
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Central Health Plan Commercial |
$704.00
|
| Rate for Payer: Cigna of CA HMO |
$616.00
|
| Rate for Payer: Cigna of CA PPO |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$352.00
|
| Rate for Payer: Galaxy Health WC |
$748.00
|
| Rate for Payer: Global Benefits Group Commercial |
$528.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$586.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.00
|
| Rate for Payer: Multiplan Commercial |
$660.00
|
| Rate for Payer: Networks By Design Commercial |
$440.00
|
| Rate for Payer: Prime Health Services Commercial |
$748.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$332.29
|
| Rate for Payer: United Healthcare All Other HMO |
$324.54
|
| Rate for Payer: United Healthcare HMO Rider |
$317.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.40
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
905355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Blue Shield of California EPN |
$372.73
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.60
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$263.56
|
| Rate for Payer: United Healthcare All Other HMO |
$257.42
|
| Rate for Payer: United Healthcare HMO Rider |
$251.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.34
|
|
|
HC AK ADDITION TEST SOCKET
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT L5624
|
| Hospital Charge Code |
905355624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$244.30 |
| Max. Negotiated Rate |
$628.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$383.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$383.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$337.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.38
|
| Rate for Payer: Blue Distinction Transplant |
$418.80
|
| Rate for Payer: Blue Shield of California Commercial |
$523.50
|
| Rate for Payer: Blue Shield of California EPN |
$379.71
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Central Health Plan Commercial |
$558.40
|
| Rate for Payer: Cigna of CA HMO |
$488.60
|
| Rate for Payer: Cigna of CA PPO |
$488.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.30
|
| Rate for Payer: Dignity Health Media |
$593.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$628.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$523.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$244.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.18
|
| Rate for Payer: Multiplan Commercial |
$523.50
|
| Rate for Payer: Networks By Design Commercial |
$349.00
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Riverside University Health System MISP |
$279.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.00
|
| Rate for Payer: United Healthcare All Other HMO |
$349.00
|
| Rate for Payer: United Healthcare HMO Rider |
$349.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$349.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$593.30
|
| Rate for Payer: Vantage Medical Group Senior |
$593.30
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
905355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.37 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$614.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$541.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$660.51
|
| Rate for Payer: Blue Distinction Transplant |
$670.80
|
| Rate for Payer: Blue Shield of California Commercial |
$838.50
|
| Rate for Payer: Blue Shield of California EPN |
$608.19
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Media |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$838.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.38
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Riverside University Health System MISP |
$447.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$559.00
|
| Rate for Payer: United Healthcare HMO Rider |
$559.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$559.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC AK ADDITION TOTAL CONTACT SKT
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT L5650
|
| Hospital Charge Code |
905355650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.60 |
| Max. Negotiated Rate |
$1,006.20 |
| Rate for Payer: Blue Shield of California EPN |
$597.01
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Central Health Plan Commercial |
$894.40
|
| Rate for Payer: Cigna of CA HMO |
$782.60
|
| Rate for Payer: Cigna of CA PPO |
$782.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,006.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.60
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Networks By Design Commercial |
$559.00
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.16
|
| Rate for Payer: United Healthcare All Other HMO |
$412.32
|
| Rate for Payer: United Healthcare HMO Rider |
$403.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$368.94
|
|
|
HC AK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Blue Shield of California EPN |
$325.21
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.80
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.96
|
| Rate for Payer: United Healthcare All Other HMO |
$224.60
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.97
|
|
|
HC AK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$609.00
|
|
|
Service Code
|
CPT L5644
|
| Hospital Charge Code |
905355644
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$548.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$517.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$334.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$334.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$294.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$359.80
|
| Rate for Payer: Blue Distinction Transplant |
$365.40
|
| Rate for Payer: Blue Shield of California Commercial |
$456.75
|
| Rate for Payer: Blue Shield of California EPN |
$331.30
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Cash Price |
$274.05
|
| Rate for Payer: Central Health Plan Commercial |
$487.20
|
| Rate for Payer: Cigna of CA HMO |
$426.30
|
| Rate for Payer: Cigna of CA PPO |
$426.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$517.65
|
| Rate for Payer: Dignity Health Media |
$517.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$517.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$243.60
|
| Rate for Payer: Galaxy Health WC |
$517.65
|
| Rate for Payer: Global Benefits Group Commercial |
$365.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$548.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$456.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$213.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$255.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.69
|
| Rate for Payer: Multiplan Commercial |
$456.75
|
| Rate for Payer: Networks By Design Commercial |
$304.50
|
| Rate for Payer: Prime Health Services Commercial |
$517.65
|
| Rate for Payer: Riverside University Health System MISP |
$243.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$365.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$365.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$304.50
|
| Rate for Payer: United Healthcare All Other HMO |
$304.50
|
| Rate for Payer: United Healthcare HMO Rider |
$304.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$517.65
|
| Rate for Payer: Vantage Medical Group Senior |
$517.65
|
|
|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
OP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,552.27 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,712.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,712.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,149.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,062.57
|
| Rate for Payer: Blue Distinction Transplant |
$5,141.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,426.75
|
| Rate for Payer: Blue Shield of California EPN |
$4,661.54
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Cash Price |
$3,856.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,855.20
|
| Rate for Payer: Cigna of CA HMO |
$5,998.30
|
| Rate for Payer: Cigna of CA PPO |
$5,998.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,283.65
|
| Rate for Payer: Dignity Health Media |
$7,283.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,283.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,427.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,427.60
|
| Rate for Payer: Galaxy Health WC |
$7,283.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,712.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,426.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,999.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,552.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,513.29
|
| Rate for Payer: Multiplan Commercial |
$6,426.75
|
| Rate for Payer: Networks By Design Commercial |
$4,284.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,283.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,427.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,284.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,284.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,284.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,284.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,283.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,283.65
|
|
