|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
OP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
915355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$437.28 |
| Max. Negotiated Rate |
$1,548.70 |
| Rate for Payer: Adventist Health Commercial |
$747.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,002.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,366.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,055.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,344.64
|
| Rate for Payer: Blue Shield of California EPN |
$885.49
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,548.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,548.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$906.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,025.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,275.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,275.40
|
| Rate for Payer: Multiplan Commercial |
$1,457.60
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,093.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,548.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,548.70
|
|
|
HC BK ADDITION SUCTION SOCKET
|
Facility
|
IP
|
$1,822.00
|
|
|
Service Code
|
CPT L5647
|
| Hospital Charge Code |
905355647
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$364.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$364.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cash Price |
$819.90
|
| Rate for Payer: Cigna of CA HMO |
$1,275.40
|
| Rate for Payer: Cigna of CA PPO |
$1,275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Senior |
$728.80
|
| Rate for Payer: Galaxy Health WC |
$1,548.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,127.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.28
|
| Rate for Payer: Multiplan Commercial |
$1,457.60
|
| Rate for Payer: Networks By Design Commercial |
$911.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,548.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.80
|
| Rate for Payer: United Healthcare All Other HMO |
$665.58
|
| Rate for Payer: United Healthcare HMO Rider |
$651.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$596.71
|
|
|
HC BK ADDITION TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
915355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.18
|
| Rate for Payer: Blue Shield of California Commercial |
$383.76
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION TEST SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
915355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC BK ADDITION TEST SOCKET
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
905355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
|
|
HC BK ADDITION TEST SOCKET
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT L5620
|
| Hospital Charge Code |
905355620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$442.00 |
| Rate for Payer: Adventist Health Commercial |
$213.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$390.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.18
|
| Rate for Payer: Blue Shield of California Commercial |
$383.76
|
| Rate for Payer: Blue Shield of California EPN |
$252.72
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Senior |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$181.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$364.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$364.00
|
| Rate for Payer: Multiplan Commercial |
$416.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.16
|
| Rate for Payer: United Healthcare All Other HMO |
$189.96
|
| Rate for Payer: United Healthcare HMO Rider |
$185.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$170.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
905355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$131.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
905355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$560.15 |
| Rate for Payer: Adventist Health Commercial |
$270.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$494.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.69
|
| Rate for Payer: Blue Shield of California Commercial |
$486.34
|
| Rate for Payer: Blue Shield of California EPN |
$320.27
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$560.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$560.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$413.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$461.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$461.30
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
915355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$131.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
|
|
HC BK ADDITION TOTAL CONTACT SCKT
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT L5637
|
| Hospital Charge Code |
915355637
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.16 |
| Max. Negotiated Rate |
$560.15 |
| Rate for Payer: Adventist Health Commercial |
$270.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$362.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$494.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.69
|
| Rate for Payer: Blue Shield of California Commercial |
$486.34
|
| Rate for Payer: Blue Shield of California EPN |
$320.27
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cash Price |
$296.55
|
| Rate for Payer: Cigna of CA HMO |
$461.30
|
| Rate for Payer: Cigna of CA PPO |
$461.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$560.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$560.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$560.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$263.60
|
| Rate for Payer: Galaxy Health WC |
$560.15
|
| Rate for Payer: Global Benefits Group Commercial |
$395.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$413.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$439.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$461.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$461.30
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Networks By Design Commercial |
$329.50
|
| Rate for Payer: Prime Health Services Commercial |
$560.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$395.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$395.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$247.32
|
| Rate for Payer: United Healthcare All Other HMO |
$240.73
|
| Rate for Payer: United Healthcare HMO Rider |
$235.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$560.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$560.15
|
| Rate for Payer: Vantage Medical Group Senior |
$560.15
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
905355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.79
|
| Rate for Payer: Blue Shield of California Commercial |
$156.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.03
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
915355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$48.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$169.40
|
| Rate for Payer: Cigna of CA PPO |
$169.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$121.00
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.82
|
| Rate for Payer: United Healthcare All Other HMO |
$88.40
|
| Rate for Payer: United Healthcare HMO Rider |
$86.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.25
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
905355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC BK ADDITION WAIST BELT
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT L5688
|
| Hospital Charge Code |
915355688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.08 |
| Max. Negotiated Rate |
$205.70 |
| Rate for Payer: Adventist Health Commercial |
$99.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$181.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.17
|
| Rate for Payer: Blue Shield of California Commercial |
$178.60
|
| Rate for Payer: Blue Shield of California EPN |
$117.61
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna of CA HMO |
$169.40
|
| Rate for Payer: Cigna of CA PPO |
$169.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$205.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Senior |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$169.40
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Networks By Design Commercial |
$121.00
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$90.82
|
| Rate for Payer: United Healthcare All Other HMO |
$88.40
|
| Rate for Payer: United Healthcare HMO Rider |
$86.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
905355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$503.28 |
| Max. Negotiated Rate |
$1,822.29 |
| Rate for Payer: Adventist Health Commercial |
$859.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,153.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,572.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,214.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,019.14
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,782.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,782.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,611.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,822.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,467.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,467.90
|
| Rate for Payer: Multiplan Commercial |
$1,677.60
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,258.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,782.45
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
905355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$419.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$1,677.60
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
OP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
915355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$503.28 |
| Max. Negotiated Rate |
$1,822.29 |
| Rate for Payer: Adventist Health Commercial |
$859.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,153.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,572.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,214.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,547.59
|
| Rate for Payer: Blue Shield of California EPN |
$1,019.14
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,782.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,782.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,611.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,822.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,467.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,467.90
|
| Rate for Payer: Multiplan Commercial |
$1,677.60
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,258.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,258.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,782.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,782.45
|
|
|
HC BK ADDITION WOOD SOCKET
|
Facility
|
IP
|
$2,097.00
|
|
|
Service Code
|
CPT L5639
|
| Hospital Charge Code |
915355639
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$419.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$419.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cash Price |
$943.65
|
| Rate for Payer: Cigna of CA HMO |
$1,467.90
|
| Rate for Payer: Cigna of CA PPO |
$1,467.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.80
|
| Rate for Payer: EPIC Health Plan Senior |
$838.80
|
| Rate for Payer: Galaxy Health WC |
$1,782.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,258.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$798.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,298.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.28
|
| Rate for Payer: Multiplan Commercial |
$1,677.60
|
| Rate for Payer: Networks By Design Commercial |
$1,048.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,782.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$787.00
|
| Rate for Payer: United Healthcare All Other HMO |
$766.03
|
| Rate for Payer: United Healthcare HMO Rider |
$749.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.77
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
905355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.36
|
| Rate for Payer: Multiplan Commercial |
$611.20
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
915355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$152.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.36
|
| Rate for Payer: Multiplan Commercial |
$611.20
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
915355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.36 |
| Max. Negotiated Rate |
$702.11 |
| Rate for Payer: Adventist Health Commercial |
$313.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$420.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$573.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$442.51
|
| Rate for Payer: Blue Shield of California Commercial |
$563.83
|
| Rate for Payer: Blue Shield of California EPN |
$371.30
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$649.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$649.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$649.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$534.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$534.80
|
| Rate for Payer: Multiplan Commercial |
$611.20
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$649.40
|
| Rate for Payer: Vantage Medical Group Senior |
$649.40
|
|
|
HC BK ADD KNEE JTS POLYCENTRIC PR
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT L5677
|
| Hospital Charge Code |
905355677
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.36 |
| Max. Negotiated Rate |
$702.11 |
| Rate for Payer: Adventist Health Commercial |
$313.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$420.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$573.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$442.51
|
| Rate for Payer: Blue Shield of California Commercial |
$563.83
|
| Rate for Payer: Blue Shield of California EPN |
$371.30
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna of CA HMO |
$534.80
|
| Rate for Payer: Cigna of CA PPO |
$534.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$649.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$649.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$649.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: EPIC Health Plan Senior |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$702.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$472.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$534.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$534.80
|
| Rate for Payer: Multiplan Commercial |
$611.20
|
| Rate for Payer: Networks By Design Commercial |
$382.00
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$286.73
|
| Rate for Payer: United Healthcare All Other HMO |
$279.09
|
| Rate for Payer: United Healthcare HMO Rider |
$273.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$250.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$649.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$649.40
|
| Rate for Payer: Vantage Medical Group Senior |
$649.40
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
915355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.80
|
| Rate for Payer: Blue Shield of California Commercial |
$645.75
|
| Rate for Payer: Blue Shield of California EPN |
$425.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
905355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$358.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$656.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.80
|
| Rate for Payer: Blue Shield of California Commercial |
$645.75
|
| Rate for Payer: Blue Shield of California EPN |
$425.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$743.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$743.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$743.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$341.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.50
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$743.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$743.75
|
| Rate for Payer: Vantage Medical Group Senior |
$743.75
|
|
|
HC BK ADD KNEE JTS SINGLE AXIS PR
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT L5676
|
| Hospital Charge Code |
915355676
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna of CA HMO |
$612.50
|
| Rate for Payer: Cigna of CA PPO |
$612.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$437.50
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.39
|
| Rate for Payer: United Healthcare All Other HMO |
$319.64
|
| Rate for Payer: United Healthcare HMO Rider |
$312.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$286.56
|
|
