|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$266.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$241.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.20
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$410.05
|
| 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 |
$451.75
|
| 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 |
$420.68
|
| Rate for Payer: Blue Shield of California Commercial |
$534.46
|
| Rate for Payer: Blue Shield of California Commercial |
$352.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$513.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$410.05
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$410.05
|
| 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 |
$451.75
|
| 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 |
$420.68
|
| Rate for Payer: Blue Shield of California Commercial |
$534.46
|
| Rate for Payer: Blue Shield of California Commercial |
$352.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$454.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$513.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$410.05
|
| 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
|
IP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
915352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 |
$313.30
|
| 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 |
$291.75
|
| Rate for Payer: Blue Shield of California Commercial |
$370.66
|
| Rate for Payer: Blue Shield of California Commercial |
$244.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 |
905352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 |
$313.30
|
| 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 |
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 |
$291.75
|
| Rate for Payer: Blue Shield of California Commercial |
$370.66
|
| Rate for Payer: Blue Shield of California Commercial |
$244.37
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$117.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$133.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| 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 |
905352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.43
|
| 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 |
$180.05
|
| 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 |
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 |
$167.67
|
| Rate for Payer: Blue Shield of California Commercial |
$213.01
|
| Rate for Payer: Blue Shield of California Commercial |
$140.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.43
|
| 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 |
915352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.43
|
| 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 |
$180.05
|
| 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 |
$167.67
|
| Rate for Payer: Blue Shield of California Commercial |
$213.01
|
| Rate for Payer: Blue Shield of California Commercial |
$140.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$175.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$163.43
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| 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 |
$125.45
|
| 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 |
915352492
|
|
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 |
$116.82
|
| Rate for Payer: Blue Shield of California Commercial |
$97.85
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| 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
|
|
|
HC ADDITION KNEE JOINT LIFT LOOP FOR DROP LOCK EA
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L2492
|
| Hospital Charge Code |
905352492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| 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 |
$125.45
|
| 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 |
$116.82
|
| Rate for Payer: Blue Shield of California Commercial |
$97.85
|
| Rate for Payer: Blue Shield of California Commercial |
$148.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.87
|
| 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
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
915352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.04
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Networks By Design Commercial |
$241.15
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
905352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.04
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Networks By Design Commercial |
$241.15
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
915352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$315.35 |
| Rate for Payer: Adventist Health Commercial |
$152.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.57
|
| Rate for Payer: Blue Shield of California Commercial |
$285.30
|
| Rate for Payer: Blue Shield of California Commercial |
$188.10
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.70
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Networks By Design Commercial |
$185.50
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
905352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$315.35 |
| Rate for Payer: Adventist Health Commercial |
$152.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.57
|
| Rate for Payer: Blue Shield of California Commercial |
$285.30
|
| Rate for Payer: Blue Shield of California Commercial |
$188.10
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.70
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Networks By Design Commercial |
$185.50
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC ADDITION KNEE LOCK BAIL TYPE EA
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT L2415
|
| Hospital Charge Code |
915352415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
|
|
HC ADDITION KNEE LOCK BAIL TYPE EA
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT L2415
|
| Hospital Charge Code |
905352415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
|
|
HC ADDITION KNEE LOCK BAIL TYPE EA
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT L2415
|
| Hospital Charge Code |
905352415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.68 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$177.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.49
|
| Rate for Payer: Blue Shield of California Commercial |
$332.21
|
| Rate for Payer: Blue Shield of California Commercial |
$219.02
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$367.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$216.00
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
|
HC ADDITION KNEE LOCK BAIL TYPE EA
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT L2415
|
| Hospital Charge Code |
915352415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$103.68 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Adventist Health Commercial |
$177.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.49
|
| Rate for Payer: Blue Shield of California Commercial |
$332.21
|
| Rate for Payer: Blue Shield of California Commercial |
$219.02
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$367.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$254.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Networks By Design Commercial |
$216.00
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
