|
HC ADD ENOSK KNEE SHIN SYS STNC
|
Facility
|
IP
|
$9,077.00
|
|
|
Service Code
|
CPT L5845
|
| Hospital Charge Code |
915355845
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,815.40 |
| Max. Negotiated Rate |
$8,169.30 |
| Rate for Payer: Adventist Health Commercial |
$1,815.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,016.52
|
| Rate for Payer: Blue Shield of California EPN |
$4,574.81
|
| Rate for Payer: Cash Price |
$4,992.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,261.60
|
| Rate for Payer: Cigna of CA HMO |
$6,353.90
|
| Rate for Payer: Cigna of CA PPO |
$6,353.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,630.80
|
| Rate for Payer: Galaxy Health WC |
$7,715.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,446.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,169.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,054.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,458.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,618.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,815.40
|
| Rate for Payer: Multiplan Commercial |
$6,807.75
|
| Rate for Payer: Networks By Design Commercial |
$5,900.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,715.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,406.60
|
| Rate for Payer: United Healthcare All Other HMO |
$3,315.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3,244.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,972.72
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
|
|
HC ADDITIONAL FROZEN SECTIONS
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
903800036
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Adventist Health Commercial |
$18.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.32
|
| Rate for Payer: Blue Shield of California Commercial |
$54.63
|
| Rate for Payer: Blue Shield of California EPN |
$35.73
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$57.60
|
| Rate for Payer: Cigna of CA PPO |
$66.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Senior |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.35
|
| Rate for Payer: InnovAge PACE Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$55.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$58.50
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.90
|
| Rate for Payer: United Healthcare All Other HMO |
$19.90
|
| Rate for Payer: United Healthcare HMO Rider |
$19.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
915356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.61 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.17
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.21
|
| Rate for Payer: InnovAge PACE Commercial |
$347.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Riverside University Health System MISP |
$278.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
915356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
905356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.00
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
905356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.61 |
| Max. Negotiated Rate |
$625.50 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$521.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.17
|
| Rate for Payer: Blue Shield of California Commercial |
$537.24
|
| Rate for Payer: Blue Shield of California EPN |
$350.28
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Central Health Plan Commercial |
$556.00
|
| Rate for Payer: Cigna of CA HMO |
$486.50
|
| Rate for Payer: Cigna of CA PPO |
$486.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$625.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.21
|
| Rate for Payer: InnovAge PACE Commercial |
$347.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$486.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$486.50
|
| Rate for Payer: Multiplan Commercial |
$521.25
|
| Rate for Payer: Networks By Design Commercial |
$347.50
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Riverside University Health System MISP |
$278.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.83
|
| Rate for Payer: United Healthcare All Other HMO |
$253.88
|
| Rate for Payer: United Healthcare HMO Rider |
$248.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$590.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.75
|
| Rate for Payer: Vantage Medical Group Senior |
$590.75
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
905352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.61 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Adventist Health Commercial |
$197.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.08
|
| Rate for Payer: Blue Shield of California Commercial |
$372.59
|
| Rate for Payer: Blue Shield of California EPN |
$242.93
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.61
|
| Rate for Payer: InnovAge PACE Commercial |
$241.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$241.00
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Riverside University Health System MISP |
$192.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
905352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Blue Shield of California Commercial |
$372.59
|
| Rate for Payer: Blue Shield of California EPN |
$242.93
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
915352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$120.61 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Adventist Health Commercial |
$197.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$283.08
|
| Rate for Payer: Blue Shield of California Commercial |
$372.59
|
| Rate for Payer: Blue Shield of California EPN |
$242.93
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$120.61
|
| Rate for Payer: InnovAge PACE Commercial |
$241.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$337.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$241.00
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Riverside University Health System MISP |
$192.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC ADDITION KNEE JOINT DISC OR DIAL LOCK EA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT L2425
|
| Hospital Charge Code |
915352425
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Blue Shield of California Commercial |
$372.59
|
| Rate for Payer: Blue Shield of California EPN |
$242.93
|
| Rate for Payer: Cash Price |
$265.10
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: Cigna of CA HMO |
$337.40
|
| Rate for Payer: Cigna of CA PPO |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$298.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.89
|
| Rate for Payer: United Healthcare All Other HMO |
$176.07
|
| Rate for Payer: United Healthcare HMO Rider |
$172.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.85
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
915352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Blue Shield of California Commercial |
$214.12
|
| Rate for Payer: Blue Shield of California EPN |
$139.61
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Central Health Plan Commercial |
$221.60
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.40
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
| Rate for Payer: Networks By Design Commercial |
$180.05
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
905352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.40 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Adventist Health Commercial |
$55.40
|
| Rate for Payer: Blue Shield of California Commercial |
$214.12
|
| Rate for Payer: Blue Shield of California EPN |
$139.61
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Central Health Plan Commercial |
$221.60
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.40
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
| Rate for Payer: Networks By Design Commercial |
$180.05
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
905352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Adventist Health Commercial |
$113.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.68
|
| Rate for Payer: Blue Shield of California Commercial |
$214.12
|
| Rate for Payer: Blue Shield of California EPN |
$139.61
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Central Health Plan Commercial |
$221.60
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.05
|
| Rate for Payer: InnovAge PACE Commercial |
$138.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.90
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
| Rate for Payer: Networks By Design Commercial |
$138.50
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Riverside University Health System MISP |
$110.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.45
|
| Rate for Payer: Vantage Medical Group Senior |
$235.45
|
|
|
HC ADDITION KNEE JOINT DROP LOCK EA
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT L2405
|
| Hospital Charge Code |
915352405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$249.30 |
| Rate for Payer: Adventist Health Commercial |
$113.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$152.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$207.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.68
|
| Rate for Payer: Blue Shield of California Commercial |
$214.12
|
| Rate for Payer: Blue Shield of California EPN |
$139.61
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Cash Price |
$152.35
|
| Rate for Payer: Central Health Plan Commercial |
$221.60
|
| Rate for Payer: Cigna of CA HMO |
$193.90
|
| Rate for Payer: Cigna of CA PPO |
$193.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$235.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$235.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$110.80
|
| Rate for Payer: Galaxy Health WC |
$235.45
|
| Rate for Payer: Global Benefits Group Commercial |
$166.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$249.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.05
|
| Rate for Payer: InnovAge PACE Commercial |
$138.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$184.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$171.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$193.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$193.90
|
| Rate for Payer: Multiplan Commercial |
$207.75
|
| Rate for Payer: Networks By Design Commercial |
$138.50
|
| Rate for Payer: Prime Health Services Commercial |
$235.45
|
| Rate for Payer: Riverside University Health System MISP |
$110.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$166.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$166.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.96
|
| Rate for Payer: United Healthcare All Other HMO |
$101.19
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$235.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$235.45
|
| Rate for Payer: Vantage Medical Group Senior |
$235.45
|
|
|
HC ADDITION KNEE JOINT LIFT LOOP FOR DROP LOCK EA
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L2492
|
| Hospital Charge Code |
905352492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC ADDITION KNEE JOINT LIFT LOOP FOR DROP LOCK EA
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT L2492
|
| Hospital Charge Code |
915352492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.60 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$38.60
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.60
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$125.45
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
|
|
HC ADDITION KNEE JOINT LIFT LOOP FOR DROP LOCK EA
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L2492
|
| Hospital Charge Code |
915352492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.35
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.38
|
| Rate for Payer: InnovAge PACE Commercial |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Riverside University Health System MISP |
$77.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC ADDITION KNEE JOINT LIFT LOOP FOR DROP LOCK EA
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT L2492
|
| Hospital Charge Code |
905352492
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$173.70 |
| Rate for Payer: Adventist Health Commercial |
$79.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$144.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.35
|
| Rate for Payer: Blue Shield of California Commercial |
$149.19
|
| Rate for Payer: Blue Shield of California EPN |
$97.27
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Cash Price |
$106.15
|
| Rate for Payer: Central Health Plan Commercial |
$154.40
|
| Rate for Payer: Cigna of CA HMO |
$135.10
|
| Rate for Payer: Cigna of CA PPO |
$135.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Senior |
$77.20
|
| Rate for Payer: Galaxy Health WC |
$164.05
|
| Rate for Payer: Global Benefits Group Commercial |
$115.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.38
|
| Rate for Payer: InnovAge PACE Commercial |
$96.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$119.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.10
|
| Rate for Payer: Multiplan Commercial |
$144.75
|
| Rate for Payer: Networks By Design Commercial |
$96.50
|
| Rate for Payer: Prime Health Services Commercial |
$164.05
|
| Rate for Payer: Riverside University Health System MISP |
$77.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.43
|
| Rate for Payer: United Healthcare All Other HMO |
$70.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.05
|
| Rate for Payer: Vantage Medical Group Senior |
$164.05
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
905352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.07 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Adventist Health Commercial |
$152.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.89
|
| Rate for Payer: Blue Shield of California Commercial |
$286.78
|
| Rate for Payer: Blue Shield of California EPN |
$186.98
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.07
|
| Rate for Payer: InnovAge PACE Commercial |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.70
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$185.50
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: Riverside University Health System MISP |
$148.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
915352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.07 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Adventist Health Commercial |
$152.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.89
|
| Rate for Payer: Blue Shield of California Commercial |
$286.78
|
| Rate for Payer: Blue Shield of California EPN |
$186.98
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.07
|
| Rate for Payer: InnovAge PACE Commercial |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.70
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$185.50
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: Riverside University Health System MISP |
$148.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
905352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Blue Shield of California Commercial |
$286.78
|
| Rate for Payer: Blue Shield of California EPN |
$186.98
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$241.15
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
|
|
HC ADDITION KNEE JOINT POLYCENTRIC EA
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L2430
|
| Hospital Charge Code |
915352430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Blue Shield of California Commercial |
$286.78
|
| Rate for Payer: Blue Shield of California EPN |
$186.98
|
| Rate for Payer: Cash Price |
$204.05
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$241.15
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
|
|
HC ADDITION KNEE LOCK BAIL TYPE EA
|
Facility
|
IP
|
$432.00
|
|
|
Service Code
|
CPT L2415
|
| Hospital Charge Code |
905352415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Adventist Health Commercial |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$333.94
|
| Rate for Payer: Blue Shield of California EPN |
$217.73
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$345.60
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$388.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$280.80
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
|
|
HC ADDITION KNEE LOCK BAIL TYPE EA
|
Facility
|
OP
|
$432.00
|
|
|
Service Code
|
CPT L2415
|
| Hospital Charge Code |
905352415
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.27 |
| Max. Negotiated Rate |
$388.80 |
| Rate for Payer: Adventist Health Commercial |
$177.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$237.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.71
|
| Rate for Payer: Blue Shield of California Commercial |
$333.94
|
| Rate for Payer: Blue Shield of California EPN |
$217.73
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Central Health Plan Commercial |
$345.60
|
| Rate for Payer: Cigna of CA HMO |
$302.40
|
| Rate for Payer: Cigna of CA PPO |
$302.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Senior |
$172.80
|
| Rate for Payer: Galaxy Health WC |
$367.20
|
| Rate for Payer: Global Benefits Group Commercial |
$259.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$388.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.27
|
| Rate for Payer: InnovAge PACE Commercial |
$216.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$216.00
|
| Rate for Payer: Prime Health Services Commercial |
$367.20
|
| Rate for Payer: Riverside University Health System MISP |
$172.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.13
|
| Rate for Payer: United Healthcare All Other HMO |
$157.81
|
| Rate for Payer: United Healthcare HMO Rider |
$154.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$367.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
