|
HC AK ADD MLTIAXIS PNEU SWG CONTR
|
Facility
|
IP
|
$8,569.00
|
|
|
Service Code
|
CPT L5840
|
| Hospital Charge Code |
905355840
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,713.80 |
| Max. Negotiated Rate |
$7,712.10 |
| Rate for Payer: Blue Shield of California EPN |
$4,575.85
|
| 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: 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: Kaiser Permanente of CA Commercial/Self Funded |
$5,715.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,264.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.80
|
| 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: United Healthcare All Other Commercial |
$3,235.65
|
| Rate for Payer: United Healthcare All Other HMO |
$3,160.25
|
| Rate for Payer: United Healthcare HMO Rider |
$3,091.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,827.77
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Blue Shield of California EPN |
$68.89
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$64.50
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.71
|
| Rate for Payer: United Healthcare All Other HMO |
$47.58
|
| Rate for Payer: United Healthcare HMO Rider |
$46.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.57
|
|
|
HC AK ADD NEOPRENE SUSPEN BELT
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT L5695
|
| Hospital Charge Code |
905355695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.15 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.21
|
| Rate for Payer: Blue Distinction Transplant |
$77.40
|
| Rate for Payer: Blue Shield of California Commercial |
$96.75
|
| Rate for Payer: Blue Shield of California EPN |
$70.18
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$90.30
|
| Rate for Payer: Cigna of CA PPO |
$90.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Media |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$96.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.89
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$64.50
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
IP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Blue Shield of California EPN |
$244.57
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.60
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$172.94
|
| Rate for Payer: United Healthcare All Other HMO |
$168.91
|
| Rate for Payer: United Healthcare HMO Rider |
$165.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.14
|
|
|
HC AK ADD PELVIC CONTRL BELT PADD
|
Facility
|
OP
|
$458.00
|
|
|
Service Code
|
CPT L5694
|
| Hospital Charge Code |
905355694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$412.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$389.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$251.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.59
|
| Rate for Payer: Blue Distinction Transplant |
$274.80
|
| Rate for Payer: Blue Shield of California Commercial |
$343.50
|
| Rate for Payer: Blue Shield of California EPN |
$249.15
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Central Health Plan Commercial |
$366.40
|
| Rate for Payer: Cigna of CA HMO |
$320.60
|
| Rate for Payer: Cigna of CA PPO |
$320.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$389.30
|
| Rate for Payer: Dignity Health Media |
$389.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$389.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$183.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$183.20
|
| Rate for Payer: Galaxy Health WC |
$389.30
|
| Rate for Payer: Global Benefits Group Commercial |
$274.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$412.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$343.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$160.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$305.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.78
|
| Rate for Payer: Multiplan Commercial |
$343.50
|
| Rate for Payer: Networks By Design Commercial |
$229.00
|
| Rate for Payer: Prime Health Services Commercial |
$389.30
|
| Rate for Payer: Riverside University Health System MISP |
$183.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$389.30
|
| Rate for Payer: Vantage Medical Group Senior |
$389.30
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$127.75 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$176.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.64
|
| Rate for Payer: Blue Distinction Transplant |
$219.00
|
| Rate for Payer: Blue Shield of California Commercial |
$273.75
|
| Rate for Payer: Blue Shield of California EPN |
$198.56
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Media |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$273.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.65
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Riverside University Health System MISP |
$146.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.50
|
| Rate for Payer: United Healthcare All Other HMO |
$182.50
|
| Rate for Payer: United Healthcare HMO Rider |
$182.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
HC AK ADD PELVIC CONTROL BELT
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L5692
|
| Hospital Charge Code |
905355692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Blue Shield of California EPN |
$194.91
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.82
|
| Rate for Payer: United Healthcare All Other HMO |
$134.61
|
| Rate for Payer: United Healthcare HMO Rider |
$131.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.45
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
OP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
905355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,294.95 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,606.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,606.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,174.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,873.88
|
| Rate for Payer: Blue Distinction Transplant |
$3,934.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,917.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,567.01
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,573.45
|
| Rate for Payer: Dignity Health Media |
$5,573.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,573.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,917.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,294.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,084.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,688.37
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,622.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,934.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,934.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,278.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,278.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,278.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,278.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,573.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,573.45
|
|
|
HC AK ADD PNEUMATIC SWING CONTROL
|
Facility
|
IP
|
$6,557.00
|
|
|
Service Code
|
CPT L5830
|
| Hospital Charge Code |
905355830
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,311.40 |
| Max. Negotiated Rate |
$5,901.30 |
| Rate for Payer: Blue Shield of California EPN |
$3,501.44
|
| Rate for Payer: Cash Price |
$2,950.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,245.60
|
| Rate for Payer: Cigna of CA HMO |
$4,589.90
|
| Rate for Payer: Cigna of CA PPO |
$4,589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,622.80
|
| Rate for Payer: Galaxy Health WC |
$5,573.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,934.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,901.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,498.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.40
|
| Rate for Payer: Multiplan Commercial |
$4,917.75
|
| Rate for Payer: Networks By Design Commercial |
$3,278.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,573.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,475.92
|
| Rate for Payer: United Healthcare All Other HMO |
$2,418.22
|
| Rate for Payer: United Healthcare HMO Rider |
$2,365.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,163.81
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
IP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
905355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$534.20 |
| Max. Negotiated Rate |
$2,403.90 |
| Rate for Payer: Blue Shield of California EPN |
$1,426.31
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,136.80
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,403.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,781.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,017.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.20
|
| Rate for Payer: Multiplan Commercial |
$2,003.25
|
| Rate for Payer: Networks By Design Commercial |
$1,335.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,008.57
|
| Rate for Payer: United Healthcare All Other HMO |
$985.06
|
| Rate for Payer: United Healthcare HMO Rider |
$963.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$881.43
|
|
|
HC AK ADD POLYCENT FRICT SWG/STNC
|
Facility
|
OP
|
$2,671.00
|
|
|
Service Code
|
CPT L5818
|
| Hospital Charge Code |
905355818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$934.85 |
| Max. Negotiated Rate |
$2,403.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,469.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,469.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,293.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,578.03
|
| Rate for Payer: Blue Distinction Transplant |
$1,602.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,003.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,453.02
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Cash Price |
$1,201.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,136.80
|
| Rate for Payer: Cigna of CA HMO |
$1,869.70
|
| Rate for Payer: Cigna of CA PPO |
$1,869.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,270.35
|
| Rate for Payer: Dignity Health Media |
$2,270.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,270.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,068.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,068.40
|
| Rate for Payer: Galaxy Health WC |
$2,270.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,602.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,403.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,003.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$934.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,781.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,384.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,095.11
|
| Rate for Payer: Multiplan Commercial |
$2,003.25
|
| Rate for Payer: Networks By Design Commercial |
$1,335.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,270.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,068.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,602.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,602.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,335.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,335.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,335.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,335.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,270.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,270.35
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
OP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
905355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$864.15 |
| Max. Negotiated Rate |
$2,222.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,357.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,357.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,195.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,458.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,481.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,851.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,343.14
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,975.20
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,098.65
|
| Rate for Payer: Dignity Health Media |
$2,098.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,098.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,222.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,851.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,646.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,012.29
|
| Rate for Payer: Multiplan Commercial |
$1,851.75
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: Riverside University Health System MISP |
$987.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,481.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,481.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,234.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,234.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,234.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,098.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,098.65
|
|
|
HC AK ADD POLYCENT MECH STANCE
|
Facility
|
IP
|
$2,469.00
|
|
|
Service Code
|
CPT L5816
|
| Hospital Charge Code |
905355816
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$493.80 |
| Max. Negotiated Rate |
$2,222.10 |
| Rate for Payer: Blue Shield of California EPN |
$1,318.45
|
| Rate for Payer: Cash Price |
$1,111.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,975.20
|
| Rate for Payer: Cigna of CA HMO |
$1,728.30
|
| Rate for Payer: Cigna of CA PPO |
$1,728.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$987.60
|
| Rate for Payer: Galaxy Health WC |
$2,098.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,481.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,222.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,646.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$940.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$493.80
|
| Rate for Payer: Multiplan Commercial |
$1,851.75
|
| Rate for Payer: Networks By Design Commercial |
$1,234.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,098.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$932.29
|
| Rate for Payer: United Healthcare All Other HMO |
$910.57
|
| Rate for Payer: United Healthcare HMO Rider |
$890.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$814.77
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
IP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
905355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,604.80 |
| Max. Negotiated Rate |
$7,221.60 |
| Rate for Payer: Blue Shield of California EPN |
$4,284.82
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,419.20
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,221.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,057.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.80
|
| Rate for Payer: Multiplan Commercial |
$6,018.00
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,029.86
|
| Rate for Payer: United Healthcare All Other HMO |
$2,959.25
|
| Rate for Payer: United Healthcare HMO Rider |
$2,895.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,647.92
|
|
|
HC AK ADD POLY PNEU SWNG FRIC STN
|
Facility
|
OP
|
$8,024.00
|
|
|
Service Code
|
CPT L5822
|
| Hospital Charge Code |
905355822
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,299.01 |
| Max. Negotiated Rate |
$7,221.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,413.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,413.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,885.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,740.58
|
| Rate for Payer: Blue Distinction Transplant |
$4,814.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,018.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,365.06
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Cash Price |
$3,610.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,419.20
|
| Rate for Payer: Cigna of CA HMO |
$5,616.80
|
| Rate for Payer: Cigna of CA PPO |
$5,616.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,820.40
|
| Rate for Payer: Dignity Health Media |
$6,820.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,820.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,209.60
|
| Rate for Payer: Galaxy Health WC |
$6,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,814.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,221.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,018.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,808.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,299.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,289.84
|
| Rate for Payer: Multiplan Commercial |
$6,018.00
|
| Rate for Payer: Networks By Design Commercial |
$4,012.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,820.40
|
| Rate for Payer: Riverside University Health System MISP |
$3,209.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,814.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,814.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,012.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,012.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,012.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,820.40
|
| Rate for Payer: Vantage Medical Group Senior |
$6,820.40
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
IP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
905355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,671.42
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,192.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.00
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,181.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,154.34
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,032.90
|
|
|
HC AK ADD SINGLE AXIS MANUAL LOCK
|
Facility
|
OP
|
$3,130.00
|
|
|
Service Code
|
CPT L5810
|
| Hospital Charge Code |
905355810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$730.57 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,721.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,721.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,515.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,849.20
|
| Rate for Payer: Blue Distinction Transplant |
$1,878.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,347.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,702.72
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Cash Price |
$1,408.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,504.00
|
| Rate for Payer: Cigna of CA HMO |
$2,191.00
|
| Rate for Payer: Cigna of CA PPO |
$2,191.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,660.50
|
| Rate for Payer: Dignity Health Media |
$2,660.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,660.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,252.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,252.00
|
| Rate for Payer: Galaxy Health WC |
$2,660.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,878.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,817.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,347.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,095.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,087.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,283.30
|
| Rate for Payer: Multiplan Commercial |
$2,347.50
|
| Rate for Payer: Networks By Design Commercial |
$1,565.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,660.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,878.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,878.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,565.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,565.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,565.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,565.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,660.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,660.50
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
IP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
905355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.40 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Blue Shield of California EPN |
$345.50
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Central Health Plan Commercial |
$517.60
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$582.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.40
|
| Rate for Payer: Multiplan Commercial |
$485.25
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.31
|
| Rate for Payer: United Healthcare All Other HMO |
$238.61
|
| Rate for Payer: United Healthcare HMO Rider |
$233.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.51
|
|
|
HC AK ADD SKT INSERT-PELITE LINER
|
Facility
|
OP
|
$647.00
|
|
|
Service Code
|
CPT L5658
|
| Hospital Charge Code |
905355658
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$226.45 |
| Max. Negotiated Rate |
$582.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$549.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$355.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$355.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$313.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.25
|
| Rate for Payer: Blue Distinction Transplant |
$388.20
|
| Rate for Payer: Blue Shield of California Commercial |
$485.25
|
| Rate for Payer: Blue Shield of California EPN |
$351.97
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Cash Price |
$291.15
|
| Rate for Payer: Central Health Plan Commercial |
$517.60
|
| Rate for Payer: Cigna of CA HMO |
$452.90
|
| Rate for Payer: Cigna of CA PPO |
$452.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$549.95
|
| Rate for Payer: Dignity Health Media |
$549.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$549.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$258.80
|
| Rate for Payer: Galaxy Health WC |
$549.95
|
| Rate for Payer: Global Benefits Group Commercial |
$388.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$582.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$485.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.27
|
| Rate for Payer: Multiplan Commercial |
$485.25
|
| Rate for Payer: Networks By Design Commercial |
$323.50
|
| Rate for Payer: Prime Health Services Commercial |
$549.95
|
| Rate for Payer: Riverside University Health System MISP |
$258.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$388.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$388.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$323.50
|
| Rate for Payer: United Healthcare All Other HMO |
$323.50
|
| Rate for Payer: United Healthcare HMO Rider |
$323.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$323.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$549.95
|
| Rate for Payer: Vantage Medical Group Senior |
$549.95
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
905355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,362.21 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,792.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,338.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,073.57
|
| Rate for Payer: Blue Distinction Transplant |
$4,137.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,171.25
|
| Rate for Payer: Blue Shield of California EPN |
$3,750.88
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Media |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,171.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,413.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,362.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,758.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,447.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,447.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,447.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,447.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AK ADD SNGL AXIS FLUID SWG CNT
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L5824
|
| Hospital Charge Code |
905355824
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,681.93
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,627.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.00
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,603.55
|
| Rate for Payer: United Healthcare All Other HMO |
$2,542.88
|
| Rate for Payer: United Healthcare HMO Rider |
$2,487.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,275.35
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Blue Shield of California EPN |
$1,154.51
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$816.37
|
| Rate for Payer: United Healthcare All Other HMO |
$797.35
|
| Rate for Payer: United Healthcare HMO Rider |
$780.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$713.46
|
|
|
HC AK ADD SNGL AXIS MAN LOCK ULTR
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT L5811
|
| Hospital Charge Code |
905355811
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$756.70 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,189.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,189.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,046.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,277.31
|
| Rate for Payer: Blue Distinction Transplant |
$1,297.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,621.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,176.13
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA HMO |
$1,513.40
|
| Rate for Payer: Cigna of CA PPO |
$1,513.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,837.70
|
| Rate for Payer: Dignity Health Media |
$1,837.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,837.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,621.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$756.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,185.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$886.42
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,081.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Riverside University Health System MISP |
$864.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,081.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,081.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,081.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,837.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,837.70
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
905355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Blue Shield of California EPN |
$658.42
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$465.58
|
| Rate for Payer: United Healthcare All Other HMO |
$454.73
|
| Rate for Payer: United Healthcare HMO Rider |
$444.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$406.89
|
|
|
HC AK/HD ADD ENDOSK ALHNABLE SYST
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT L5920
|
| Hospital Charge Code |
905355920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$431.55 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$678.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$597.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$728.46
|
| Rate for Payer: Blue Distinction Transplant |
$739.80
|
| Rate for Payer: Blue Shield of California Commercial |
$924.75
|
| Rate for Payer: Blue Shield of California EPN |
$670.75
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Cash Price |
$554.85
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$863.10
|
| Rate for Payer: Cigna of CA PPO |
$863.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.05
|
| Rate for Payer: Dignity Health Media |
$1,048.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,048.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$924.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$431.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.53
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$616.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Riverside University Health System MISP |
$493.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.50
|
| Rate for Payer: United Healthcare All Other HMO |
$616.50
|
| Rate for Payer: United Healthcare HMO Rider |
$616.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,048.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.05
|
|
