|
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: Cigna of CA PPO |
$8,954.40
|
| 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 |
$7,743.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,837.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6,485.54
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,470.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,547.28
|
| 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
|
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 |
$7,743.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,837.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6,485.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,470.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,122.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,547.28
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$243.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$220.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$205.32
|
| 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 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 |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.31
|
| Rate for Payer: Blue Shield of California Commercial |
$146.51
|
| Rate for Payer: Blue Shield of California Commercial |
$222.02
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$243.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$220.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| 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 |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,281.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,512.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,979.70
|
| 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 |
$578.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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 |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,281.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| 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/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$75.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,512.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,839.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,064.74
|
| 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 |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,593.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,981.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,557.21
|
| 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 |
$420.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$794.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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 |
$1,191.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$874.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$794.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,593.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,311.06
|
| Rate for Payer: EPIC Health Plan Senior |
$874.04
|
| 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/Senior |
$1,303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$59.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$794.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,981.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,112.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,260.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,064.74
|
| 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 |
$794.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,191.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$874.04
|
| Rate for Payer: Vantage Medical Group Senior |
$794.58
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$433.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.97
|
| 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 |
$443.95
|
| 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 |
905352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$433.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.97
|
| 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 |
$443.95
|
| 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 |
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 |
$413.42
|
| Rate for Payer: Blue Shield of California Commercial |
$525.23
|
| Rate for Payer: Blue Shield of California Commercial |
$346.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.97
|
| 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 |
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 |
$413.42
|
| Rate for Payer: Blue Shield of California Commercial |
$525.23
|
| Rate for Payer: Blue Shield of California Commercial |
$346.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$288.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$326.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.97
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$359.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.94
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$113.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$359.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$333.94
|
| 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 |
$283.00
|
| 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 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 |
$667.65
|
| Rate for Payer: Blue Shield of California Commercial |
$848.21
|
| Rate for Payer: Blue Shield of California Commercial |
$559.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$700.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$505.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$650.77
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$700.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$650.77
|
| 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 |
$716.95
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$700.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$650.77
|
| 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 |
$716.95
|
| 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 |
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 |
$667.65
|
| Rate for Payer: Blue Shield of California Commercial |
$848.21
|
| Rate for Payer: Blue Shield of California Commercial |
$559.22
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$446.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$700.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$505.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$650.77
|
| 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 |
905352622
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| 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 |
$505.70
|
| 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: Vantage Medical Group Senior |
$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 |
$470.92
|
| Rate for Payer: Blue Shield of California Commercial |
$598.28
|
| Rate for Payer: Blue Shield of California Commercial |
$394.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| 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 |
$505.70
|
| 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 |
$470.92
|
| Rate for Payer: Blue Shield of California Commercial |
$598.28
|
| Rate for Payer: Blue Shield of California Commercial |
$394.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$400.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| 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 |
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 |
$579.27
|
| Rate for Payer: Blue Shield of California Commercial |
$735.93
|
| Rate for Payer: Blue Shield of California Commercial |
$485.20
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.63
|
| 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
|
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 |
$579.27
|
| Rate for Payer: Blue Shield of California Commercial |
$735.93
|
| Rate for Payer: Blue Shield of California Commercial |
$485.20
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cash Price |
$430.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$232.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.63
|
| 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 |
$14,109.00 |
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Adventist Health Commercial |
$191.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$430.65
|
| Rate for Payer: Cigna of CA HMO |
$669.90
|
| Rate for Payer: Cigna of CA PPO |
$669.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$607.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.63
|
| 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 |
$622.05
|
| 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
|
|
