|
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 |
$5,180.45
|
| 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 |
$5,180.45
|
| Rate for Payer: Cash Price |
$5,180.45
|
| Rate for Payer: Cash Price |
$5,180.45
|
| Rate for Payer: Cash Price |
$5,180.45
|
| 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
|
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 |
$375.65
|
| Rate for Payer: Cash Price |
$375.65
|
| 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 |
$375.65
|
| Rate for Payer: Cash Price |
$375.65
|
| 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
|
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 |
$375.65
|
| Rate for Payer: Cash Price |
$375.65
|
| 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 |
$375.65
|
| Rate for Payer: Cash Price |
$375.65
|
| 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 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 |
$311.30
|
| Rate for Payer: Cash Price |
$311.30
|
| Rate for Payer: Cash Price |
$311.30
|
| 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 |
$311.30
|
| 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
|
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 |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| 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 |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| 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
|
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 |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| 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 |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| 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 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: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$427.90
|
| Rate for Payer: Cash Price |
$427.90
|
| 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 |
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 |
$427.90
|
| Rate for Payer: Cash Price |
$427.90
|
| 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 |
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 |
$427.90
|
| Rate for Payer: Cash Price |
$427.90
|
| 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 |
$427.90
|
| Rate for Payer: Cash Price |
$427.90
|
| 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 CLEVIS OR THRUST BEARIN
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
905352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.67 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Adventist Health Commercial |
$392.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.29
|
| Rate for Payer: Blue Shield of California Commercial |
$706.27
|
| Rate for Payer: Blue Shield of California EPN |
$465.10
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$813.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.90
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.45
|
| Rate for Payer: Vantage Medical Group Senior |
$813.45
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
905352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
915352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$205.67 |
| Max. Negotiated Rate |
$813.45 |
| Rate for Payer: Adventist Health Commercial |
$392.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$526.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$717.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.29
|
| Rate for Payer: Blue Shield of California Commercial |
$706.27
|
| Rate for Payer: Blue Shield of California EPN |
$465.10
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$813.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$813.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$813.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$669.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$669.90
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$813.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$813.45
|
| Rate for Payer: Vantage Medical Group Senior |
$813.45
|
|
|
HC HIP JT CLEVIS OR THRUST BEARIN
|
Facility
|
IP
|
$957.00
|
|
|
Service Code
|
CPT L2600
|
| Hospital Charge Code |
915352600
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cash Price |
$526.35
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.80
|
| Rate for Payer: EPIC Health Plan Senior |
$382.80
|
| Rate for Payer: Galaxy Health WC |
$813.45
|
| Rate for Payer: Global Benefits Group Commercial |
$574.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$592.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.68
|
| Rate for Payer: Multiplan Commercial |
$765.60
|
| Rate for Payer: Networks By Design Commercial |
$478.50
|
| Rate for Payer: Prime Health Services Commercial |
$813.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$359.16
|
| Rate for Payer: United Healthcare All Other HMO |
$349.59
|
| Rate for Payer: United Healthcare HMO Rider |
$342.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$313.42
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
915352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
905352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.36 |
| Max. Negotiated Rate |
$1,371.90 |
| Rate for Payer: Adventist Health Commercial |
$661.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$934.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.13
|
| Rate for Payer: Blue Shield of California EPN |
$784.40
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$432.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,129.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,129.80
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HIP JT CLEVIS TYPE 2 POS EA
|
Facility
|
OP
|
$1,614.00
|
|
|
Service Code
|
CPT L2570
|
| Hospital Charge Code |
915352570
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$387.36 |
| Max. Negotiated Rate |
$1,371.90 |
| Rate for Payer: Adventist Health Commercial |
$661.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,210.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$934.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.13
|
| Rate for Payer: Blue Shield of California EPN |
$784.40
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cash Price |
$887.70
|
| Rate for Payer: Cigna of CA HMO |
$1,129.80
|
| Rate for Payer: Cigna of CA PPO |
$1,129.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,371.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,371.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$432.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$489.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$387.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,129.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,129.80
|
| Rate for Payer: Multiplan Commercial |
$1,291.20
|
| Rate for Payer: Networks By Design Commercial |
$807.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$968.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$968.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.73
|
| Rate for Payer: United Healthcare All Other HMO |
$589.59
|
| Rate for Payer: United Healthcare HMO Rider |
$576.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,371.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,371.90
|
|
|
HC HIP JT HEAVY DUTY EA
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT L2620
|
| Hospital Charge Code |
905352620
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$653.95
|
| Rate for Payer: Cash Price |
$653.95
|
| Rate for Payer: Cigna of CA HMO |
$832.30
|
| Rate for Payer: Cigna of CA PPO |
$832.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$594.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$446.23
|
| Rate for Payer: United Healthcare All Other HMO |
$434.34
|
| Rate for Payer: United Healthcare HMO Rider |
$424.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.40
|
|
