|
HC ADAPTOR MED KIT BLV-BIS-10
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT C1883
|
| Hospital Charge Code |
906812495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$1,661.75 |
| Rate for Payer: Adventist Health Commercial |
$391.00
|
| Rate for Payer: Cash Price |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.00
|
| Rate for Payer: EPIC Health Plan Senior |
$782.00
|
| Rate for Payer: Galaxy Health WC |
$1,661.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,303.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$744.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,210.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.20
|
| Rate for Payer: Multiplan Commercial |
$1,564.00
|
| Rate for Payer: Networks By Design Commercial |
$1,270.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,661.75
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
905352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
915352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
915352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC ADD ABDOMINAL BAND/STAP
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L2660
|
| Hospital Charge Code |
905352660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
OP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
905355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,896.54 |
| Max. Negotiated Rate |
$7,715.45 |
| Rate for Payer: Adventist Health Commercial |
$3,721.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,992.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,807.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,257.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,698.83
|
| Rate for Payer: Blue Shield of California EPN |
$4,411.42
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,715.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,715.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,896.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,144.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,353.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,353.90
|
| Rate for Payer: Multiplan Commercial |
$7,261.60
|
| Rate for Payer: Networks By Design Commercial |
$4,538.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,446.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,446.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,715.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,715.45
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
OP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
915355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,896.54 |
| Max. Negotiated Rate |
$7,715.45 |
| Rate for Payer: Adventist Health Commercial |
$3,721.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,992.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,807.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,257.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,698.83
|
| Rate for Payer: Blue Shield of California EPN |
$4,411.42
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,715.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,715.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,896.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,144.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,353.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,353.90
|
| Rate for Payer: Multiplan Commercial |
$7,261.60
|
| Rate for Payer: Networks By Design Commercial |
$4,538.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,446.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,446.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,715.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,715.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,715.45
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
IP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
905355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,815.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,815.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,458.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.48
|
| Rate for Payer: Multiplan Commercial |
$7,261.60
|
| Rate for Payer: Networks By Design Commercial |
$4,538.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
|
|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
IP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
915355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,815.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,815.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cash Price |
$4,084.65
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,458.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.48
|
| Rate for Payer: Multiplan Commercial |
$7,261.60
|
| Rate for Payer: Networks By Design Commercial |
$4,538.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Adventist Health Commercial |
$76.00
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$152.00
|
| Rate for Payer: Galaxy Health WC |
$323.00
|
| Rate for Payer: Global Benefits Group Commercial |
$228.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$253.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$235.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.20
|
| Rate for Payer: Multiplan Commercial |
$304.00
|
| Rate for Payer: Networks By Design Commercial |
$247.00
|
| Rate for Payer: Prime Health Services Commercial |
$323.00
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$82.39 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.39
|
| Rate for Payer: Blue Shield of California Commercial |
$60.21
|
| Rate for Payer: Blue Shield of California EPN |
$39.78
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
905356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
905356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.54
|
| Rate for Payer: Blue Shield of California Commercial |
$512.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.77
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
915356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
915356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$402.54
|
| Rate for Payer: Blue Shield of California Commercial |
$512.91
|
| Rate for Payer: Blue Shield of California EPN |
$337.77
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
915352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$197.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.17
|
| Rate for Payer: Blue Shield of California Commercial |
$355.72
|
| Rate for Payer: Blue Shield of California EPN |
$234.25
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$241.00
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
915352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$241.00
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
905352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$241.00
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
905352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$197.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$279.17
|
| Rate for Payer: Blue Shield of California Commercial |
$355.72
|
| Rate for Payer: Blue Shield of California EPN |
$234.25
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$241.00
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
915352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.48
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Networks By Design Commercial |
$138.50
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
915352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.54 |
| Max. Negotiated Rate |
$235.45 |
| Rate for Payer: Adventist Health Commercial |
$113.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.44
|
| Rate for Payer: Blue Shield of California Commercial |
$204.43
|
| Rate for Payer: Blue Shield of California EPN |
$134.62
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.90
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Networks By Design Commercial |
$138.50
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.45
|
| Rate for Payer: Vantage Medical Group Senior |
$235.45
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
905352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.54 |
| Max. Negotiated Rate |
$235.45 |
| Rate for Payer: Adventist Health Commercial |
$113.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.44
|
| Rate for Payer: Blue Shield of California Commercial |
$204.43
|
| Rate for Payer: Blue Shield of California EPN |
$134.62
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.90
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Networks By Design Commercial |
$138.50
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.45
|
| Rate for Payer: Vantage Medical Group Senior |
$235.45
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
905352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.48
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Networks By Design Commercial |
$138.50
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
|
|
HC ADDITION KNEE JOINT LIFT LOOP FOR DROP LOCK EA
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L2492
|
| Hospital Charge Code |
915352492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC ADDITION KNEE JOINT LIFT LOOP FOR DROP LOCK EA
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L2492
|
| Hospital Charge Code |
905352492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.32 |
| Max. Negotiated Rate |
$164.05 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.79
|
| Rate for Payer: Blue Shield of California Commercial |
$142.43
|
| Rate for Payer: Blue Shield of California EPN |
$93.80
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
