|
HC HFO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
915353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,470.64 |
| Max. Negotiated Rate |
$10,873.20 |
| Rate for Payer: Adventist Health Commercial |
$5,244.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,035.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,409.13
|
| Rate for Payer: Blue Shield of California Commercial |
$9,440.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,216.91
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,873.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,873.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,470.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,070.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,954.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,954.40
|
| Rate for Payer: Multiplan Commercial |
$10,233.60
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,675.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,675.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,873.20
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,558.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,558.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,873.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,070.08
|
| Rate for Payer: Multiplan Commercial |
$10,233.60
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
915355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,558.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,558.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,873.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,070.08
|
| Rate for Payer: Multiplan Commercial |
$10,233.60
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
915355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,470.64 |
| Max. Negotiated Rate |
$10,873.20 |
| Rate for Payer: Adventist Health Commercial |
$5,244.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,035.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,409.13
|
| Rate for Payer: Blue Shield of California Commercial |
$9,440.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,216.91
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,873.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,873.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,470.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,070.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,954.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,954.40
|
| Rate for Payer: Multiplan Commercial |
$10,233.60
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,675.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,675.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,873.20
|
|
|
HC HIGH FLOW 02
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.71
|
| Rate for Payer: Blue Shield of California Commercial |
$212.98
|
| Rate for Payer: Blue Shield of California EPN |
$140.59
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC HIGH FLOW 02
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$295.80 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
IP
|
$11,830.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,366.00 |
| Max. Negotiated Rate |
$10,055.50 |
| Rate for Payer: Adventist Health Commercial |
$2,366.00
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,732.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,732.00
|
| Rate for Payer: Galaxy Health WC |
$10,055.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,098.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,890.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,507.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,322.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,839.20
|
| Rate for Payer: Multiplan Commercial |
$9,464.00
|
| Rate for Payer: Networks By Design Commercial |
$7,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,055.50
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
OP
|
$11,830.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.26 |
| Max. Negotiated Rate |
$10,055.50 |
| Rate for Payer: Adventist Health Commercial |
$2,366.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,759.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cash Price |
$5,323.50
|
| Rate for Payer: Cigna of CA HMO |
$7,571.20
|
| Rate for Payer: Cigna of CA PPO |
$8,754.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$10,055.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,098.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,890.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,839.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$9,464.00
|
| Rate for Payer: Networks By Design Commercial |
$7,689.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,055.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,098.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,098.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
IP
|
$9,419.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,883.80 |
| Max. Negotiated Rate |
$8,006.15 |
| Rate for Payer: Adventist Health Commercial |
$1,883.80
|
| Rate for Payer: Cash Price |
$4,238.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,767.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,767.60
|
| Rate for Payer: Galaxy Health WC |
$8,006.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,651.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,282.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,588.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,830.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.56
|
| Rate for Payer: Multiplan Commercial |
$7,535.20
|
| Rate for Payer: Networks By Design Commercial |
$6,122.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,006.15
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
OP
|
$9,419.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.30 |
| Max. Negotiated Rate |
$8,006.15 |
| Rate for Payer: Adventist Health Commercial |
$1,883.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,177.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$4,238.55
|
| Rate for Payer: Cash Price |
$4,238.55
|
| Rate for Payer: Cash Price |
$4,238.55
|
| Rate for Payer: Cash Price |
$4,238.55
|
| Rate for Payer: Cigna of CA HMO |
$6,028.16
|
| Rate for Payer: Cigna of CA PPO |
$6,970.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$8,006.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,651.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,282.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,058.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$7,535.20
|
| Rate for Payer: Networks By Design Commercial |
$6,122.35
|
| Rate for Payer: Prime Health Services Commercial |
$8,006.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,651.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,651.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
905352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.92 |
| Max. Negotiated Rate |
$580.55 |
| Rate for Payer: Adventist Health Commercial |
$280.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$512.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.59
|
| Rate for Payer: Blue Shield of California Commercial |
$504.05
|
| Rate for Payer: Blue Shield of California EPN |
$331.94
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$580.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$580.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$580.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.10
|
| Rate for Payer: Multiplan Commercial |
$546.40
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$580.55
|
| Rate for Payer: Vantage Medical Group Senior |
$580.55
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
905352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.92
|
| Rate for Payer: Multiplan Commercial |
$546.40
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
915352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.92
|
| Rate for Payer: Multiplan Commercial |
$546.40
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
915352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$163.92 |
| Max. Negotiated Rate |
$580.55 |
| Rate for Payer: Adventist Health Commercial |
$280.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$512.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.59
|
| Rate for Payer: Blue Shield of California Commercial |
$504.05
|
| Rate for Payer: Blue Shield of California EPN |
$331.94
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$580.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$580.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$580.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$163.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.10
|
| Rate for Payer: Multiplan Commercial |
$546.40
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$580.55
|
| Rate for Payer: Vantage Medical Group Senior |
$580.55
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna of CA HMO |
$362.24
|
| Rate for Payer: Cigna of CA PPO |
$418.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$396.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$396.20
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$481.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.10
|
| Rate for Payer: Vantage Medical Group Senior |
$481.10
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: EPIC Health Plan Senior |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
915352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.72 |
| Max. Negotiated Rate |
$937.55 |
| Rate for Payer: Adventist Health Commercial |
$452.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$937.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$606.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$827.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$638.86
|
| Rate for Payer: Blue Shield of California Commercial |
$814.01
|
| Rate for Payer: Blue Shield of California EPN |
$536.06
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$937.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$937.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$937.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$772.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$772.10
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Networks By Design Commercial |
$551.50
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.96
|
| Rate for Payer: United Healthcare All Other HMO |
$402.93
|
| Rate for Payer: United Healthcare HMO Rider |
$394.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$937.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$937.55
|
| Rate for Payer: Vantage Medical Group Senior |
$937.55
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
905352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.72 |
| Max. Negotiated Rate |
$937.55 |
| Rate for Payer: Adventist Health Commercial |
$452.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$937.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$606.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$827.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$638.86
|
| Rate for Payer: Blue Shield of California Commercial |
$814.01
|
| Rate for Payer: Blue Shield of California EPN |
$536.06
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$937.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$937.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$937.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$772.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$772.10
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Networks By Design Commercial |
$551.50
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.96
|
| Rate for Payer: United Healthcare All Other HMO |
$402.93
|
| Rate for Payer: United Healthcare HMO Rider |
$394.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$937.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$937.55
|
| Rate for Payer: Vantage Medical Group Senior |
$937.55
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
915352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.72
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Networks By Design Commercial |
$551.50
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.96
|
| Rate for Payer: United Healthcare All Other HMO |
$402.93
|
| Rate for Payer: United Healthcare HMO Rider |
$394.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.23
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
905352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.72
|
| Rate for Payer: Multiplan Commercial |
$882.40
|
| Rate for Payer: Networks By Design Commercial |
$551.50
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.96
|
| Rate for Payer: United Healthcare All Other HMO |
$402.93
|
| Rate for Payer: United Healthcare HMO Rider |
$394.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.23
|
|
|
HC HIP JT ADJ FLEXION EA
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT L2622
|
| Hospital Charge Code |
915352622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.72 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$318.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$427.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$583.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.62
|
| Rate for Payer: Blue Shield of California Commercial |
$574.16
|
| Rate for Payer: Blue Shield of California EPN |
$378.11
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$544.60
|
| Rate for Payer: Cigna of CA PPO |
$544.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$661.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$661.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$544.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$544.60
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$389.00
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.98
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$278.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$661.30
|
| Rate for Payer: Vantage Medical Group Senior |
$661.30
|
|
|
HC HIP JT ADJ FLEXION EA
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT L2622
|
| Hospital Charge Code |
915352622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$389.00
|
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$544.60
|
| Rate for Payer: Cigna of CA PPO |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.98
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$278.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.79
|
|
|
HC HIP JT ADJ FLEXION EA
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT L2622
|
| Hospital Charge Code |
905352622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$544.60
|
| Rate for Payer: Cigna of CA PPO |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$389.00
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.98
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$278.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.79
|
|
|
HC HIP JT ADJ FLEXION EA
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT L2622
|
| Hospital Charge Code |
905352622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.72 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$318.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$427.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$583.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.62
|
| Rate for Payer: Blue Shield of California Commercial |
$574.16
|
| Rate for Payer: Blue Shield of California EPN |
$378.11
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$544.60
|
| Rate for Payer: Cigna of CA PPO |
$544.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$661.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$661.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$544.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$544.60
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$389.00
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.98
|
| Rate for Payer: United Healthcare All Other HMO |
$284.20
|
| Rate for Payer: United Healthcare HMO Rider |
$278.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$661.30
|
| Rate for Payer: Vantage Medical Group Senior |
$661.30
|
|
