|
HC FX OX ADJ MOTION KNEE JT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
905352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$192.95 |
| Rate for Payer: Adventist Health Commercial |
$93.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.48
|
| Rate for Payer: Blue Shield of California Commercial |
$167.53
|
| Rate for Payer: Blue Shield of California EPN |
$110.32
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Senior |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$140.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.90
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.19
|
| Rate for Payer: United Healthcare All Other HMO |
$82.92
|
| Rate for Payer: United Healthcare HMO Rider |
$81.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC FX OX DROP LOCK
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
905352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC FX OX DROP LOCK
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
905352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$215.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.08
|
| Rate for Payer: Blue Shield of California Commercial |
$387.45
|
| Rate for Payer: Blue Shield of California EPN |
$255.15
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$367.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC FX OX DROP LOCK
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
915352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
|
|
HC FX OX DROP LOCK
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
915352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$446.25 |
| Rate for Payer: Adventist Health Commercial |
$215.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.08
|
| Rate for Payer: Blue Shield of California Commercial |
$387.45
|
| Rate for Payer: Blue Shield of California EPN |
$255.15
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$367.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.03
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
915352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.96 |
| Max. Negotiated Rate |
$662.15 |
| Rate for Payer: Adventist Health Commercial |
$319.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$428.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$584.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.20
|
| Rate for Payer: Blue Shield of California Commercial |
$574.90
|
| Rate for Payer: Blue Shield of California EPN |
$378.59
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$662.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$662.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$662.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$545.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$545.30
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$467.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$467.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$662.15
|
| Rate for Payer: Vantage Medical Group Senior |
$662.15
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
905352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$155.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
IP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
915352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$155.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
|
OP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
905352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.96 |
| Max. Negotiated Rate |
$662.15 |
| Rate for Payer: Adventist Health Commercial |
$319.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$428.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$584.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.20
|
| Rate for Payer: Blue Shield of California Commercial |
$574.90
|
| Rate for Payer: Blue Shield of California EPN |
$378.59
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$662.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$662.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$662.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Senior |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$482.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$545.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$545.30
|
| Rate for Payer: Multiplan Commercial |
$623.20
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$467.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$467.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.36
|
| Rate for Payer: United Healthcare All Other HMO |
$284.57
|
| Rate for Payer: United Healthcare HMO Rider |
$278.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$255.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$662.15
|
| Rate for Payer: Vantage Medical Group Senior |
$662.15
|
|
|
HC FX OX HUMERAL
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$550.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.83
|
| Rate for Payer: United Healthcare All Other HMO |
$401.83
|
| Rate for Payer: United Healthcare HMO Rider |
$393.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.25
|
|
|
HC FX OX HUMERAL
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
915353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.12
|
| Rate for Payer: Blue Shield of California Commercial |
$811.80
|
| Rate for Payer: Blue Shield of California EPN |
$534.60
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$550.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.83
|
| Rate for Payer: United Healthcare All Other HMO |
$401.83
|
| Rate for Payer: United Healthcare HMO Rider |
$393.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.00
|
| Rate for Payer: Vantage Medical Group Senior |
$935.00
|
|
|
HC FX OX HUMERAL
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$935.00 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.12
|
| Rate for Payer: Blue Shield of California Commercial |
$811.80
|
| Rate for Payer: Blue Shield of California EPN |
$534.60
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$550.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.83
|
| Rate for Payer: United Healthcare All Other HMO |
$401.83
|
| Rate for Payer: United Healthcare HMO Rider |
$393.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.00
|
| Rate for Payer: Vantage Medical Group Senior |
$935.00
|
|
|
HC FX OX HUMERAL
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905363980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$259.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$259.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna of CA HMO |
$908.60
|
| Rate for Payer: Cigna of CA PPO |
$908.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$519.20
|
| Rate for Payer: Galaxy Health WC |
$1,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$778.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$803.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.52
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: Networks By Design Commercial |
$649.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,103.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.14
|
| Rate for Payer: United Healthcare All Other HMO |
$474.16
|
| Rate for Payer: United Healthcare HMO Rider |
$463.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.10
|
|
|
HC FX OX HUMERAL
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
915353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Senior |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$680.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Networks By Design Commercial |
$550.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.83
|
| Rate for Payer: United Healthcare All Other HMO |
$401.83
|
| Rate for Payer: United Healthcare HMO Rider |
$393.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.25
|
|
|
HC FX OX HUMERAL
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905363980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.52 |
| Max. Negotiated Rate |
$1,103.30 |
| Rate for Payer: Adventist Health Commercial |
$532.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$713.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$973.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$751.80
|
| Rate for Payer: Blue Shield of California Commercial |
$957.92
|
| Rate for Payer: Blue Shield of California EPN |
$630.83
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna of CA HMO |
$908.60
|
| Rate for Payer: Cigna of CA PPO |
$908.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,103.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,103.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$519.20
|
| Rate for Payer: Galaxy Health WC |
$1,103.30
|
| Rate for Payer: Global Benefits Group Commercial |
$778.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$803.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$908.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$908.60
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: Networks By Design Commercial |
$649.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,103.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$778.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$778.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$487.14
|
| Rate for Payer: United Healthcare All Other HMO |
$474.16
|
| Rate for Payer: United Healthcare HMO Rider |
$463.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,103.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,103.30
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
915352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
915352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.33 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$324.35
|
| Rate for Payer: Blue Shield of California Commercial |
$413.28
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
905352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.33 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$420.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$324.35
|
| Rate for Payer: Blue Shield of California Commercial |
$413.28
|
| Rate for Payer: Blue Shield of California EPN |
$272.16
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$392.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
905352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Senior |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$346.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.17
|
| Rate for Payer: United Healthcare All Other HMO |
$204.57
|
| Rate for Payer: United Healthcare HMO Rider |
$200.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$183.40
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
915352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$769.25 |
| Rate for Payer: Adventist Health Commercial |
$371.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.18
|
| Rate for Payer: Blue Shield of California Commercial |
$667.89
|
| Rate for Payer: Blue Shield of California EPN |
$439.83
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$769.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$769.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$769.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$633.50
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$769.25
|
| Rate for Payer: Vantage Medical Group Senior |
$769.25
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
OP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$769.25 |
| Rate for Payer: Adventist Health Commercial |
$371.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.18
|
| Rate for Payer: Blue Shield of California Commercial |
$667.89
|
| Rate for Payer: Blue Shield of California EPN |
$439.83
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$769.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$769.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$769.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$633.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$633.50
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$769.25
|
| Rate for Payer: Vantage Medical Group Senior |
$769.25
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
|
|
HC FX OX QUAD BRIM
|
Facility
|
IP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
915352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$724.00
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.65
|
| Rate for Payer: United Healthcare All Other HMO |
$330.60
|
| Rate for Payer: United Healthcare HMO Rider |
$323.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.39
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
OP
|
$720.00
|
|
|
Service Code
|
CPT L3982
|
| Hospital Charge Code |
915353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$295.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$396.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$540.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$417.02
|
| Rate for Payer: Blue Shield of California Commercial |
$531.36
|
| Rate for Payer: Blue Shield of California EPN |
$349.92
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$612.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$492.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$557.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$504.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$432.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$432.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$612.00
|
| Rate for Payer: Vantage Medical Group Senior |
$612.00
|
|
|
HC FX OX RADIUS ULNAR
|
Facility
|
IP
|
$720.00
|
|
|
Service Code
|
CPT L3982
|
| Hospital Charge Code |
915353982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$144.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$504.00
|
| Rate for Payer: Cigna of CA PPO |
$504.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.00
|
| Rate for Payer: EPIC Health Plan Senior |
$288.00
|
| Rate for Payer: Galaxy Health WC |
$612.00
|
| Rate for Payer: Global Benefits Group Commercial |
$432.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$480.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$445.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$360.00
|
| Rate for Payer: Prime Health Services Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$270.22
|
| Rate for Payer: United Healthcare All Other HMO |
$263.02
|
| Rate for Payer: United Healthcare HMO Rider |
$257.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.80
|
|
