|
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 |
915352415
|
|
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
|
|
|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
915353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
915353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
905353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC ADD JOINT UPPER EXT ORTHOSIS
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3956
|
| Hospital Charge Code |
905353956
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
905355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$779.45 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Adventist Health Commercial |
$975.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,309.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,397.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,839.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.52
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,904.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,023.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,142.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,164.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,190.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,587.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,286.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,473.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,666.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,666.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: Riverside University Health System MISP |
$952.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,428.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,428.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,023.00
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
OP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
915355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$779.45 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Adventist Health Commercial |
$975.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,309.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,785.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,397.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,839.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.52
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,904.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,023.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,142.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,164.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1,190.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,587.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,286.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,473.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,666.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,666.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.00
|
| Rate for Payer: Networks By Design Commercial |
$1,190.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: Riverside University Health System MISP |
$952.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,428.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,428.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,023.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,023.00
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
915355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Adventist Health Commercial |
$476.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,839.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.52
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,904.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,142.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,587.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$906.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,473.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.00
|
| Rate for Payer: Networks By Design Commercial |
$1,547.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
|
|
HC ADD KNEE/SHIN SWING PHASE ONLY
|
Facility
|
IP
|
$2,380.00
|
|
|
Service Code
|
CPT L5848
|
| Hospital Charge Code |
905355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Adventist Health Commercial |
$476.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,839.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,199.52
|
| Rate for Payer: Cash Price |
$1,309.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,904.00
|
| Rate for Payer: Cigna of CA HMO |
$1,666.00
|
| Rate for Payer: Cigna of CA PPO |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Senior |
$952.00
|
| Rate for Payer: Galaxy Health WC |
$2,023.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,428.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,142.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,587.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$906.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,473.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.00
|
| Rate for Payer: Multiplan Commercial |
$1,785.00
|
| Rate for Payer: Networks By Design Commercial |
$1,547.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,023.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$893.21
|
| Rate for Payer: United Healthcare All Other HMO |
$869.41
|
| Rate for Payer: United Healthcare HMO Rider |
$850.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.45
|
|
|
HC ADDL DIAG CD19
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$268.44 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.48
|
| Rate for Payer: Blue Shield of California Commercial |
$174.82
|
| Rate for Payer: Blue Shield of California EPN |
$114.34
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Senior |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: InnovAge PACE Commercial |
$56.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC ADDL DIAG CD19
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
905352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Blue Shield of California Commercial |
$404.28
|
| Rate for Payer: Blue Shield of California EPN |
$263.59
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
915352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.42 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$214.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.16
|
| Rate for Payer: Blue Shield of California Commercial |
$404.28
|
| Rate for Payer: Blue Shield of California EPN |
$263.59
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$444.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.42
|
| Rate for Payer: InnovAge PACE Commercial |
$261.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$366.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.10
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$261.50
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Riverside University Health System MISP |
$209.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
915352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Blue Shield of California Commercial |
$404.28
|
| Rate for Payer: Blue Shield of California EPN |
$263.59
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
|
|
HC ADD LE-CARBON GRAPHITE LAMINAT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT L2755
|
| Hospital Charge Code |
905352755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.42 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$214.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$287.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$307.16
|
| Rate for Payer: Blue Shield of California Commercial |
$404.28
|
| Rate for Payer: Blue Shield of California EPN |
$263.59
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$444.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.42
|
| Rate for Payer: InnovAge PACE Commercial |
$261.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$366.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.10
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$261.50
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Riverside University Health System MISP |
$209.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$444.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$444.55
|
| Rate for Payer: Vantage Medical Group Senior |
$444.55
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.20
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
905355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$678.25 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,035.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Riverside University Health System MISP |
$828.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
915355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$678.25 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,035.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Riverside University Health System MISP |
$828.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD LE, CUSTOM ROSS CONGENITAL
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5681
|
| Hospital Charge Code |
905355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.20
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
905355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.20
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.20
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
905355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$678.25 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,035.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Riverside University Health System MISP |
$828.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD LE CUSTOM SILICONE INSERT
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$678.25 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Adventist Health Commercial |
$849.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,553.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,216.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,600.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,043.78
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.80
|
| Rate for Payer: Cigna of CA HMO |
$1,449.70
|
| Rate for Payer: Cigna of CA PPO |
$1,449.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,760.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: InnovAge PACE Commercial |
$1,035.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.70
|
| Rate for Payer: Multiplan Commercial |
$1,553.25
|
| Rate for Payer: Networks By Design Commercial |
$1,035.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Riverside University Health System MISP |
$828.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.25
|
| Rate for Payer: United Healthcare All Other HMO |
$756.54
|
| Rate for Payer: United Healthcare HMO Rider |
$740.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$678.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,760.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,760.35
|
|
|
HC ADD. LE FOOT LAMIN/PREPREG COMPOSIT
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT L3031
|
| Hospital Charge Code |
905353031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.60 |
| Max. Negotiated Rate |
$470.70 |
| Rate for Payer: Adventist Health Commercial |
$104.60
|
| Rate for Payer: Blue Shield of California Commercial |
$404.28
|
| Rate for Payer: Blue Shield of California EPN |
$263.59
|
| Rate for Payer: Cash Price |
$287.65
|
| Rate for Payer: Central Health Plan Commercial |
$418.40
|
| Rate for Payer: Cigna of CA HMO |
$366.10
|
| Rate for Payer: Cigna of CA PPO |
$366.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Senior |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$470.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.60
|
| Rate for Payer: Multiplan Commercial |
$392.25
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.28
|
| Rate for Payer: United Healthcare All Other HMO |
$191.05
|
| Rate for Payer: United Healthcare HMO Rider |
$186.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.28
|
|
