|
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 |
$249.99
|
| Rate for Payer: Blue Shield of California Commercial |
$317.60
|
| Rate for Payer: Blue Shield of California Commercial |
$209.39
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Cash Price |
$185.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$262.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.67
|
| 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
|
$487.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905362795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cigna of CA HMO |
$340.90
|
| Rate for Payer: Cigna of CA PPO |
$340.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.33
|
| 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 |
$316.55
|
| 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
|
$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 |
$294.78
|
| Rate for Payer: Blue Shield of California Commercial |
$374.50
|
| Rate for Payer: Blue Shield of California Commercial |
$246.91
|
| Rate for Payer: Cash Price |
$219.15
|
| Rate for Payer: Cash Price |
$219.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$309.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$287.33
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.32
|
| 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 |
$291.20
|
| 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 |
$271.17
|
| Rate for Payer: Blue Shield of California Commercial |
$344.51
|
| Rate for Payer: Blue Shield of California Commercial |
$227.14
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.32
|
| 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
|
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 |
$271.17
|
| Rate for Payer: Blue Shield of California Commercial |
$344.51
|
| Rate for Payer: Blue Shield of California Commercial |
$227.14
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.32
|
| 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 |
915352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$284.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$264.32
|
| 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 |
$291.20
|
| 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 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 |
$6,190.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,864.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5,184.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,886.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,526.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.56
|
| 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 |
905355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,045.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$6,493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.56
|
| 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 |
$6,647.15
|
| 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 |
915355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,045.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$6,493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.56
|
| 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 |
$6,647.15
|
| 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 |
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 |
$6,190.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,864.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5,184.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$4,886.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,493.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,526.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,033.56
|
| 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 |
$36,281.68
|
| Rate for Payer: Blue Shield of California Commercial |
$30,389.58
|
| Rate for Payer: Blue Shield of California Commercial |
$46,093.86
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38,061.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,364.60
|
| 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
|
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 |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$38,061.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$35,364.60
|
| 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 |
$38,961.00
|
| 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
|
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 |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$24,384.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,656.00
|
| 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 |
$24,960.00
|
| 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
|
$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 |
$23,243.52
|
| Rate for Payer: Blue Shield of California Commercial |
$19,468.80
|
| Rate for Payer: Blue Shield of California Commercial |
$29,529.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$24,384.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,656.00
|
| 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 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 |
$152.46 |
| Rate for Payer: Adventist Health Commercial |
$8.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.46
|
| 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 |
$25.89
|
| Rate for Payer: Cash Price |
$18.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$25.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.80
|
| 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 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: Multiplan Commercial |
$32.27
|
| Rate for Payer: Networks By Design Commercial |
$26.22
|
| Rate for Payer: Adventist Health Commercial |
$8.07
|
| Rate for Payer: Cash Price |
$18.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.24
|
| 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 Foundation Hospitals Commercial/Self Funded |
$25.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.68
|
| Rate for Payer: Prime Health Services Commercial |
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.54
|
| 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 Foundation Hospitals Commercial/Self Funded |
$51.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.65
|
| 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 |
$152.46 |
| Rate for Payer: Adventist Health Commercial |
$16.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.46
|
| 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 |
$51.83
|
| Rate for Payer: Cash Price |
$36.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.54
|
| 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 Foundation Hospitals Commercial/Self Funded |
$51.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.65
|
| 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 |
$175.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.72
|
| Rate for Payer: Blue Shield of California Commercial |
$293.86
|
| Rate for Payer: Blue Shield of California Commercial |
$445.32
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$593.30
|
| Rate for Payer: Global Benefits Group Commercial |
$418.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$488.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$443.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$411.82
|
| 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
|
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 |
$666.44
|
| Rate for Payer: Blue Shield of California Commercial |
$846.67
|
| Rate for Payer: Blue Shield of California Commercial |
$558.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| 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
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| 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 |
$715.65
|
| 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 |
$666.44
|
| Rate for Payer: Blue Shield of California Commercial |
$846.67
|
| Rate for Payer: Blue Shield of California Commercial |
$558.21
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$645.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$729.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| 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
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
915351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$220.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$699.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$649.59
|
| 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 |
$715.65
|
| 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
|
|
