|
HC FX OX ADD SOCK
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.64
|
| Rate for Payer: Blue Shield of California Commercial |
$92.28
|
| Rate for Payer: Blue Shield of California Commercial |
$60.84
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC FX OX ADD SOCK
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
915353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
|
|
HC FX OX ADD SOCK
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
915353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.64
|
| Rate for Payer: Blue Shield of California Commercial |
$92.28
|
| Rate for Payer: Blue Shield of California Commercial |
$60.84
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.04
|
| Rate for Payer: United Healthcare All Other HMO |
$43.84
|
| Rate for Payer: United Healthcare HMO Rider |
$42.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
905352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| 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
|
|
|
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 |
$137.40
|
| Rate for Payer: Blue Shield of California Commercial |
$174.56
|
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| 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 ADJ MOTION KNEE JT
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
915352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$45.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.48
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| 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
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
915352186
|
|
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 |
$137.40
|
| Rate for Payer: Blue Shield of California Commercial |
$174.56
|
| Rate for Payer: Blue Shield of California Commercial |
$115.09
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$144.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.93
|
| 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
|
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 |
$317.78
|
| Rate for Payer: Blue Shield of California Commercial |
$403.73
|
| Rate for Payer: Blue Shield of California Commercial |
$266.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| 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 |
905352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| 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 |
$341.25
|
| 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 |
$317.78
|
| Rate for Payer: Blue Shield of California Commercial |
$403.73
|
| Rate for Payer: Blue Shield of California Commercial |
$266.18
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| 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 |
$341.25
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Adventist Health Commercial |
$155.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$494.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.61
|
| 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 |
$506.35
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$155.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$494.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.61
|
| 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 |
$506.35
|
| 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 |
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 |
$471.53
|
| Rate for Payer: Blue Shield of California Commercial |
$599.05
|
| Rate for Payer: Blue Shield of California Commercial |
$394.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$475.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.61
|
| 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
|
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 |
$471.53
|
| Rate for Payer: Blue Shield of California Commercial |
$599.05
|
| Rate for Payer: Blue Shield of California Commercial |
$394.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$420.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$475.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.61
|
| 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 |
915353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$698.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.00
|
| 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 |
$715.00
|
| 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 |
$665.83
|
| Rate for Payer: Blue Shield of California Commercial |
$845.90
|
| Rate for Payer: Blue Shield of California Commercial |
$557.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$698.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.00
|
| 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 |
$665.83
|
| Rate for Payer: Blue Shield of California Commercial |
$845.90
|
| Rate for Payer: Blue Shield of California Commercial |
$557.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$408.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$698.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$461.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.00
|
| 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
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$698.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.00
|
| 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 |
$715.00
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| 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 |
$364.00
|
| 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
|
IP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
915352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$112.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| 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 |
$364.00
|
| 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 |
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 |
$338.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.64
|
| Rate for Payer: Blue Shield of California Commercial |
$283.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| 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 |
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 |
$338.97
|
| Rate for Payer: Blue Shield of California Commercial |
$430.64
|
| Rate for Payer: Blue Shield of California Commercial |
$283.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$355.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.40
|
| 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 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 |
$547.80
|
| Rate for Payer: Blue Shield of California Commercial |
$695.95
|
| Rate for Payer: Blue Shield of California Commercial |
$458.83
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$574.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$533.95
|
| 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 |
915352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$181.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$574.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$533.95
|
| 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 |
$588.25
|
| 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
|
|
