|
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 |
$4,601.87
|
| Rate for Payer: Cash Price |
$4,601.87
|
| 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
|
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 |
$4,601.87
|
| Rate for Payer: Cash Price |
$4,601.87
|
| 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 |
$4,601.87
|
| Rate for Payer: Cash Price |
$4,601.87
|
| 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-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 |
$26,973.00
|
| 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-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 |
$17,280.00
|
| 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 |
$17,280.00
|
| Rate for Payer: Cash Price |
$17,280.00
|
| 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
|
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 |
$26,973.00
|
| Rate for Payer: Cash Price |
$26,973.00
|
| 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 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 |
$18.15
|
| 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
|
|
|
HC KNEE SLEEVE OPEN PATELLA LRG
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$26.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.77
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Cigna of CA HMO |
$25.82
|
| Rate for Payer: Cigna of CA PPO |
$29.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.29
|
| 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: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.24
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.17
|
| Rate for Payer: United Healthcare All Other HMO |
$20.17
|
| Rate for Payer: United Healthcare HMO Rider |
$20.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.29
|
|
|
HC KNEE SLEEVE OPEN PATELLA XLRG
|
Facility
|
IP
|
$80.77
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607659
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$68.65 |
| Rate for Payer: Adventist Health Commercial |
$16.15
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.31
|
| Rate for Payer: Galaxy Health WC |
$68.65
|
| Rate for Payer: Global Benefits Group Commercial |
$48.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Multiplan Commercial |
$64.62
|
| Rate for Payer: Networks By Design Commercial |
$52.50
|
| Rate for Payer: Prime Health Services Commercial |
$68.65
|
|
|
HC KNEE SLEEVE OPEN PATELLA XLRG
|
Facility
|
OP
|
$80.77
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607659
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$68.65 |
| Rate for Payer: Adventist Health Commercial |
$16.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.60
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Cigna of CA HMO |
$51.69
|
| Rate for Payer: Cigna of CA PPO |
$59.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: EPIC Health Plan Senior |
$32.31
|
| Rate for Payer: Galaxy Health WC |
$68.65
|
| Rate for Payer: Global Benefits Group Commercial |
$48.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.54
|
| Rate for Payer: Multiplan Commercial |
$64.62
|
| Rate for Payer: Networks By Design Commercial |
$52.50
|
| Rate for Payer: Prime Health Services Commercial |
$68.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.38
|
| Rate for Payer: United Healthcare All Other HMO |
$40.38
|
| Rate for Payer: United Healthcare HMO Rider |
$40.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.65
|
| Rate for Payer: Vantage Medical Group Senior |
$68.65
|
|
|
HC KNEE STANDING
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$457.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.44
|
| Rate for Payer: Blue Shield of California Commercial |
$427.18
|
| Rate for Payer: Blue Shield of California EPN |
$281.99
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna of CA HMO |
$446.72
|
| Rate for Payer: Cigna of CA PPO |
$516.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$418.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$418.80
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC KNEE STANDING
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.60 |
| Max. Negotiated Rate |
$593.30 |
| Rate for Payer: Adventist Health Commercial |
$139.60
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$279.20
|
| Rate for Payer: EPIC Health Plan Senior |
$279.20
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$465.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$432.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Networks By Design Commercial |
$453.70
|
| Rate for Payer: Prime Health Services Commercial |
$593.30
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.24
|
| Rate for Payer: Multiplan Commercial |
$880.80
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.24
|
| Rate for Payer: Multiplan Commercial |
$880.80
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.24 |
| Max. Negotiated Rate |
$935.85 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.70
|
| Rate for Payer: Blue Shield of California Commercial |
$812.54
|
| Rate for Payer: Blue Shield of California EPN |
$535.09
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$880.80
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.24 |
| Max. Negotiated Rate |
$935.85 |
| Rate for Payer: Adventist Health Commercial |
$451.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$825.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$637.70
|
| Rate for Payer: Blue Shield of California Commercial |
$812.54
|
| Rate for Payer: Blue Shield of California EPN |
$535.09
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Senior |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$681.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$264.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$770.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$770.70
|
| Rate for Payer: Multiplan Commercial |
$880.80
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.21
|
| Rate for Payer: United Healthcare All Other HMO |
$402.20
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$360.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
915351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.96
|
| Rate for Payer: Multiplan Commercial |
$723.20
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
905351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$180.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.96
|
| Rate for Payer: Multiplan Commercial |
$723.20
|
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
915351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.96 |
| Max. Negotiated Rate |
$768.40 |
| Rate for Payer: Adventist Health Commercial |
$370.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$523.60
|
| Rate for Payer: Blue Shield of California Commercial |
$667.15
|
| Rate for Payer: Blue Shield of California EPN |
$439.34
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$768.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$632.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$632.80
|
| Rate for Payer: Multiplan Commercial |
$723.20
|
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.40
|
| Rate for Payer: Vantage Medical Group Senior |
$768.40
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
905351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$216.96 |
| Max. Negotiated Rate |
$768.40 |
| Rate for Payer: Dignity Health Medi-Cal |
$768.40
|
| Rate for Payer: Adventist Health Commercial |
$370.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$678.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$523.60
|
| Rate for Payer: Blue Shield of California Commercial |
$667.15
|
| Rate for Payer: Blue Shield of California EPN |
$439.34
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$768.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Senior |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$488.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$559.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$632.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$632.80
|
| Rate for Payer: Multiplan Commercial |
$723.20
|
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$339.27
|
| Rate for Payer: United Healthcare All Other HMO |
$330.23
|
| Rate for Payer: United Healthcare HMO Rider |
$323.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.40
|
| Rate for Payer: Vantage Medical Group Senior |
$768.40
|
|
|
HC KO CTI TYPE
|
Facility
|
IP
|
$1,870.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$374.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$374.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO |
$1,309.00
|
| Rate for Payer: Cigna of CA PPO |
$1,309.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$748.00
|
| Rate for Payer: Galaxy Health WC |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.80
|
| Rate for Payer: Multiplan Commercial |
$1,496.00
|
| Rate for Payer: Networks By Design Commercial |
$935.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.81
|
| Rate for Payer: United Healthcare All Other HMO |
$683.11
|
| Rate for Payer: United Healthcare HMO Rider |
$668.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.42
|
|
|
HC KO CTI TYPE
|
Facility
|
OP
|
$1,870.00
|
|
|
Service Code
|
CPT L1846
|
| Hospital Charge Code |
905351858
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$448.80 |
| Max. Negotiated Rate |
$1,589.50 |
| Rate for Payer: Adventist Health Commercial |
$766.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,028.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,402.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,083.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,380.06
|
| Rate for Payer: Blue Shield of California EPN |
$908.82
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cash Price |
$841.50
|
| Rate for Payer: Cigna of CA HMO |
$1,309.00
|
| Rate for Payer: Cigna of CA PPO |
$1,309.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,589.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,589.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$748.00
|
| Rate for Payer: Galaxy Health WC |
$1,589.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,122.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,082.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,247.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,157.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,309.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,309.00
|
| Rate for Payer: Multiplan Commercial |
$1,496.00
|
| Rate for Payer: Networks By Design Commercial |
$935.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,589.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,122.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,122.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.81
|
| Rate for Payer: United Healthcare All Other HMO |
$683.11
|
| Rate for Payer: United Healthcare HMO Rider |
$668.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$612.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,589.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,589.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,589.50
|
|
|
HC KO DBL UPRIGHT ADJ FE\LEX/EXT
|
Facility
|
IP
|
$1,733.00
|
|
|
Service Code
|
CPT L1845
|
| Hospital Charge Code |
905361845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$346.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$346.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cigna of CA HMO |
$1,213.10
|
| Rate for Payer: Cigna of CA PPO |
$1,213.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$693.20
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$660.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,072.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.92
|
| Rate for Payer: Multiplan Commercial |
$1,386.40
|
| Rate for Payer: Networks By Design Commercial |
$866.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$650.39
|
| Rate for Payer: United Healthcare All Other HMO |
$633.06
|
| Rate for Payer: United Healthcare HMO Rider |
$619.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.56
|
|
|
HC KO DBL UPRIGHT ADJ FE\LEX/EXT
|
Facility
|
OP
|
$1,733.00
|
|
|
Service Code
|
CPT L1845
|
| Hospital Charge Code |
905361845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$415.92 |
| Max. Negotiated Rate |
$1,473.05 |
| Rate for Payer: Adventist Health Commercial |
$710.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,473.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$953.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,299.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,003.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,278.95
|
| Rate for Payer: Blue Shield of California EPN |
$842.24
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cash Price |
$779.85
|
| Rate for Payer: Cigna of CA HMO |
$1,213.10
|
| Rate for Payer: Cigna of CA PPO |
$1,213.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,473.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,473.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,473.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$693.20
|
| Rate for Payer: EPIC Health Plan Senior |
$693.20
|
| Rate for Payer: Galaxy Health WC |
$1,473.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,039.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$587.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,155.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,072.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,213.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,213.10
|
| Rate for Payer: Multiplan Commercial |
$1,386.40
|
| Rate for Payer: Networks By Design Commercial |
$866.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,473.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,039.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,039.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$650.39
|
| Rate for Payer: United Healthcare All Other HMO |
$633.06
|
| Rate for Payer: United Healthcare HMO Rider |
$619.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,473.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,473.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,473.05
|
|
