|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Cash Price |
$481.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$743.75 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.69
|
| Rate for Payer: Blue Shield of California Commercial |
$535.50
|
| Rate for Payer: Blue Shield of California EPN |
$353.50
|
| Rate for Payer: Cash Price |
$481.25
|
| Rate for Payer: Cash Price |
$481.25
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$46.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$700.00
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
905352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.52
|
| Rate for Payer: Blue Shield of California Commercial |
$144.65
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
905352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
915352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$166.60 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.52
|
| Rate for Payer: Blue Shield of California Commercial |
$144.65
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
915352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.04
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
915352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905362795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$100.31 |
| Max. Negotiated Rate |
$413.95 |
| Rate for Payer: Adventist Health Commercial |
$199.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.07
|
| Rate for Payer: Blue Shield of California Commercial |
$359.41
|
| Rate for Payer: Blue Shield of California EPN |
$236.68
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cigna of CA HMO |
$340.90
|
| Rate for Payer: Cigna of CA PPO |
$340.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.90
|
| Rate for Payer: Multiplan Commercial |
$389.60
|
| Rate for Payer: Networks By Design Commercial |
$243.50
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.77
|
| Rate for Payer: United Healthcare All Other HMO |
$177.90
|
| Rate for Payer: United Healthcare HMO Rider |
$174.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.95
|
| Rate for Payer: Vantage Medical Group Senior |
$413.95
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.12 |
| Max. Negotiated Rate |
$351.05 |
| Rate for Payer: Adventist Health Commercial |
$169.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.21
|
| Rate for Payer: Blue Shield of California Commercial |
$304.79
|
| Rate for Payer: Blue Shield of California EPN |
$200.72
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cigna of CA HMO |
$289.10
|
| Rate for Payer: Cigna of CA PPO |
$289.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$206.50
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.87
|
| Rate for Payer: United Healthcare HMO Rider |
$147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cigna of CA HMO |
$289.10
|
| Rate for Payer: Cigna of CA PPO |
$289.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$206.50
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.87
|
| Rate for Payer: United Healthcare HMO Rider |
$147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.26
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905362795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cigna of CA HMO |
$340.90
|
| Rate for Payer: Cigna of CA PPO |
$340.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.88
|
| Rate for Payer: Multiplan Commercial |
$389.60
|
| Rate for Payer: Networks By Design Commercial |
$243.50
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.77
|
| Rate for Payer: United Healthcare All Other HMO |
$177.90
|
| Rate for Payer: United Healthcare HMO Rider |
$174.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.49
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
915352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.72
|
| Rate for Payer: Blue Shield of California Commercial |
$258.30
|
| Rate for Payer: Blue Shield of California EPN |
$170.10
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
915352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$224.00
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
915352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Adventist Health Commercial |
$183.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.48
|
| Rate for Payer: Blue Shield of California Commercial |
$330.62
|
| Rate for Payer: Blue Shield of California EPN |
$217.73
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.60
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$224.00
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$380.80
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
905352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$224.00
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
905352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$380.80 |
| Rate for Payer: Adventist Health Commercial |
$183.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$259.48
|
| Rate for Payer: Blue Shield of California Commercial |
$330.62
|
| Rate for Payer: Blue Shield of California EPN |
$217.73
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.60
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Networks By Design Commercial |
$224.00
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$380.80
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
OP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
905355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,454.33 |
| Max. Negotiated Rate |
$8,692.42 |
| Rate for Payer: Adventist Health Commercial |
$4,192.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,624.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,669.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,923.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,547.07
|
| Rate for Payer: Blue Shield of California EPN |
$4,970.02
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,692.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,692.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,886.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,526.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,158.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,158.47
|
| Rate for Payer: Multiplan Commercial |
$8,181.10
|
| Rate for Payer: Networks By Design Commercial |
$5,113.19
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,135.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,135.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8,692.42
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
OP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
915355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,454.33 |
| Max. Negotiated Rate |
$8,692.42 |
| Rate for Payer: Adventist Health Commercial |
$4,192.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,624.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,669.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,923.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,547.07
|
| Rate for Payer: Blue Shield of California EPN |
$4,970.02
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,692.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,692.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,886.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,526.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,158.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,158.47
|
| Rate for Payer: Multiplan Commercial |
$8,181.10
|
| Rate for Payer: Networks By Design Commercial |
$5,113.19
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,135.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,135.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8,692.42
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
IP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
915355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,045.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,896.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.33
|
| Rate for Payer: Multiplan Commercial |
$8,181.10
|
| Rate for Payer: Networks By Design Commercial |
$5,113.19
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
IP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
905355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,045.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,896.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,454.33
|
| Rate for Payer: Multiplan Commercial |
$8,181.10
|
| Rate for Payer: Networks By Design Commercial |
$5,113.19
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
|
|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
IP
|
$59,940.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
905355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,988.00 |
| Max. Negotiated Rate |
$50,949.00 |
| Rate for Payer: Adventist Health Commercial |
$11,988.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$32,967.00
|
| Rate for Payer: Cash Price |
$32,967.00
|
| Rate for Payer: Cigna of CA HMO |
$41,958.00
|
| Rate for Payer: Cigna of CA PPO |
$41,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,976.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23,976.00
|
| Rate for Payer: Galaxy Health WC |
$50,949.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35,964.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,979.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,837.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,102.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,385.60
|
| Rate for Payer: Multiplan Commercial |
$47,952.00
|
| Rate for Payer: Networks By Design Commercial |
$29,970.00
|
| Rate for Payer: Prime Health Services Commercial |
$50,949.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,495.48
|
| Rate for Payer: United Healthcare All Other HMO |
$21,896.08
|
| Rate for Payer: United Healthcare HMO Rider |
$21,422.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,630.35
|
|
|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
OP
|
$38,400.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
915355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9,216.00 |
| Max. Negotiated Rate |
$32,640.00 |
| Rate for Payer: Adventist Health Commercial |
$15,744.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32,640.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21,120.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28,800.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22,241.28
|
| Rate for Payer: Blue Shield of California Commercial |
$28,339.20
|
| Rate for Payer: Blue Shield of California EPN |
$18,662.40
|
| Rate for Payer: Cash Price |
$21,120.00
|
| Rate for Payer: Cigna of CA HMO |
$26,880.00
|
| Rate for Payer: Cigna of CA PPO |
$26,880.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32,640.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$32,640.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32,640.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,360.00
|
| Rate for Payer: Galaxy Health WC |
$32,640.00
|
| Rate for Payer: Global Benefits Group Commercial |
$23,040.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,612.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,769.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,216.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26,880.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26,880.00
|
| Rate for Payer: Multiplan Commercial |
$30,720.00
|
| Rate for Payer: Networks By Design Commercial |
$19,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$32,640.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23,040.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23,040.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,411.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14,027.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13,724.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,576.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32,640.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32,640.00
|
| Rate for Payer: Vantage Medical Group Senior |
$32,640.00
|
|
|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
IP
|
$38,400.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
915355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,680.00 |
| Max. Negotiated Rate |
$32,640.00 |
| Rate for Payer: Adventist Health Commercial |
$7,680.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$21,120.00
|
| Rate for Payer: Cash Price |
$21,120.00
|
| Rate for Payer: Cigna of CA HMO |
$26,880.00
|
| Rate for Payer: Cigna of CA PPO |
$26,880.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,360.00
|
| Rate for Payer: EPIC Health Plan Senior |
$15,360.00
|
| Rate for Payer: Galaxy Health WC |
$32,640.00
|
| Rate for Payer: Global Benefits Group Commercial |
$23,040.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25,612.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14,630.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23,769.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,216.00
|
| Rate for Payer: Multiplan Commercial |
$30,720.00
|
| Rate for Payer: Networks By Design Commercial |
$19,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$32,640.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,411.52
|
| Rate for Payer: United Healthcare All Other HMO |
$14,027.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13,724.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,576.00
|
|
|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
OP
|
$59,940.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
905355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14,385.60 |
| Max. Negotiated Rate |
$50,949.00 |
| Rate for Payer: Adventist Health Commercial |
$24,575.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50,949.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,967.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,955.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34,717.25
|
| Rate for Payer: Blue Shield of California Commercial |
$44,235.72
|
| Rate for Payer: Blue Shield of California EPN |
$29,130.84
|
| Rate for Payer: Cash Price |
$32,967.00
|
| Rate for Payer: Cigna of CA HMO |
$41,958.00
|
| Rate for Payer: Cigna of CA PPO |
$41,958.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50,949.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,949.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50,949.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,976.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23,976.00
|
| Rate for Payer: Galaxy Health WC |
$50,949.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35,964.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,979.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,102.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,385.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,958.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,958.00
|
| Rate for Payer: Multiplan Commercial |
$47,952.00
|
| Rate for Payer: Networks By Design Commercial |
$29,970.00
|
| Rate for Payer: Prime Health Services Commercial |
$50,949.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,964.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35,964.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,495.48
|
| Rate for Payer: United Healthcare All Other HMO |
$21,896.08
|
| Rate for Payer: United Healthcare HMO Rider |
$21,422.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,630.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50,949.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,949.00
|
| Rate for Payer: Vantage Medical Group Senior |
$50,949.00
|
|
|
HC KNEE SLEEVE OPEN PATELLA LRG
|
Facility
|
IP
|
$40.34
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607658
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$34.29 |
| Rate for Payer: Adventist Health Commercial |
$8.07
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.14
|
| Rate for Payer: EPIC Health Plan Senior |
$16.14
|
| Rate for Payer: Galaxy Health WC |
$34.29
|
| Rate for Payer: Global Benefits Group Commercial |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.68
|
| Rate for Payer: Multiplan Commercial |
$32.27
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Prime Health Services Commercial |
$34.29
|
|
