|
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: Blue Shield of California EPN |
$371.13
|
| Rate for Payer: Cash Price |
$312.75
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$139.00
|
| 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: United Healthcare All Other Commercial |
$262.43
|
| Rate for Payer: United Healthcare All Other HMO |
$256.32
|
| Rate for Payer: United Healthcare HMO Rider |
$250.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.35
|
|
|
HC ADDITIONAL SWITCH, EXT POWER
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT L6611
|
| Hospital Charge Code |
905356611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$243.25 |
| Max. Negotiated Rate |
$625.50 |
| 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 |
$382.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.61
|
| Rate for Payer: Blue Distinction Transplant |
$417.00
|
| Rate for Payer: Blue Shield of California Commercial |
$521.25
|
| Rate for Payer: Blue Shield of California EPN |
$378.08
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| 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 Media |
$590.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$521.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.25
|
| 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: LLUH Dept of Risk Management WC |
$284.95
|
| 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 |
$347.50
|
| Rate for Payer: United Healthcare All Other HMO |
$347.50
|
| Rate for Payer: United Healthcare HMO Rider |
$347.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$347.50
|
| 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 |
$133.23 |
| Max. Negotiated Rate |
$433.80 |
| 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 |
$265.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.77
|
| Rate for Payer: Blue Distinction Transplant |
$289.20
|
| Rate for Payer: Blue Shield of California Commercial |
$361.50
|
| Rate for Payer: Blue Shield of California EPN |
$262.21
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| 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 Media |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.70
|
| 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: LLUH Dept of Risk Management WC |
$197.62
|
| 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 |
$241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.00
|
| 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: Blue Shield of California EPN |
$257.39
|
| Rate for Payer: Cash Price |
$216.90
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$96.40
|
| 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: United Healthcare All Other Commercial |
$182.00
|
| Rate for Payer: United Healthcare All Other HMO |
$177.76
|
| Rate for Payer: United Healthcare HMO Rider |
$173.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.06
|
|
|
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 |
$71.86 |
| Max. Negotiated Rate |
$249.30 |
| 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 |
$152.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.65
|
| Rate for Payer: Blue Distinction Transplant |
$166.20
|
| Rate for Payer: Blue Shield of California Commercial |
$207.75
|
| Rate for Payer: Blue Shield of California EPN |
$150.69
|
| Rate for Payer: Cash Price |
$124.65
|
| Rate for Payer: Cash Price |
$124.65
|
| 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 Media |
$235.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$235.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$207.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.95
|
| 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: LLUH Dept of Risk Management WC |
$113.57
|
| 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 |
$138.50
|
| Rate for Payer: United Healthcare All Other HMO |
$138.50
|
| Rate for Payer: United Healthcare HMO Rider |
$138.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.50
|
| 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
|
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: Blue Shield of California EPN |
$147.92
|
| Rate for Payer: Cash Price |
$124.65
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$55.40
|
| 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: United Healthcare All Other Commercial |
$104.60
|
| Rate for Payer: United Healthcare All Other HMO |
$102.16
|
| Rate for Payer: United Healthcare HMO Rider |
$99.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.41
|
|
|
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 |
$67.55 |
| Max. Negotiated Rate |
$173.70 |
| 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 |
$106.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.02
|
| Rate for Payer: Blue Distinction Transplant |
$115.80
|
| Rate for Payer: Blue Shield of California Commercial |
$144.75
|
| Rate for Payer: Blue Shield of California EPN |
$104.99
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| 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 Media |
$164.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$144.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.55
|
| 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: LLUH Dept of Risk Management WC |
$79.13
|
| 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 |
$96.50
|
| Rate for Payer: United Healthcare All Other HMO |
$96.50
|
| Rate for Payer: United Healthcare HMO Rider |
$96.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.50
|
| 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
|
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: Blue Shield of California EPN |
$103.06
|
| Rate for Payer: Cash Price |
$86.85
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$38.60
|
| 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: United Healthcare All Other Commercial |
$72.88
|
| Rate for Payer: United Healthcare All Other HMO |
$71.18
|
| Rate for Payer: United Healthcare HMO Rider |
$69.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.69
|
|
|
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 |
$88.44 |
| Max. Negotiated Rate |
$333.90 |
| 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 |
$204.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.19
|
| Rate for Payer: Blue Distinction Transplant |
$222.60
|
| Rate for Payer: Blue Shield of California Commercial |
$278.25
|
| Rate for Payer: Blue Shield of California EPN |
$201.82
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| 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 Media |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$278.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.85
|
| 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: LLUH Dept of Risk Management WC |
$152.11
|
| 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 |
$185.50
|
| Rate for Payer: United Healthcare All Other HMO |
$185.50
|
| Rate for Payer: United Healthcare HMO Rider |
$185.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.50
|
| 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: Blue Shield of California EPN |
$198.11
|
| Rate for Payer: Cash Price |
$166.95
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$74.20
|
| 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: United Healthcare All Other Commercial |
$140.09
|
| Rate for Payer: United Healthcare All Other HMO |
$136.82
|
| Rate for Payer: United Healthcare HMO Rider |
$133.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.43
|
|
|
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 |
$139.48 |
| Max. Negotiated Rate |
$388.80 |
| 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 |
$237.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$209.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.23
|
| Rate for Payer: Blue Distinction Transplant |
$259.20
|
| Rate for Payer: Blue Shield of California Commercial |
$324.00
|
| Rate for Payer: Blue Shield of California EPN |
$235.01
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| 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 Media |
$367.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$367.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$324.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$151.20
|
| 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: LLUH Dept of Risk Management WC |
$177.12
|
| 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 |
$216.00
|
| Rate for Payer: United Healthcare All Other HMO |
$216.00
|
| Rate for Payer: United Healthcare HMO Rider |
$216.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$367.20
|
| Rate for Payer: Vantage Medical Group Senior |
$367.20
|
|
|
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: Blue Shield of California EPN |
$230.69
|
| Rate for Payer: Cash Price |
$194.40
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$86.40
|
| 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: United Healthcare All Other Commercial |
$163.12
|
| Rate for Payer: United Healthcare All Other HMO |
$159.32
|
| Rate for Payer: United Healthcare HMO Rider |
$155.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.56
|
|
|
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 |
$46.20 |
| Max. Negotiated Rate |
$118.80 |
| 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 |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.99
|
| Rate for Payer: Blue Distinction Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$99.00
|
| Rate for Payer: Blue Shield of California EPN |
$71.81
|
| Rate for Payer: Cash Price |
$59.40
|
| 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 Media |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| 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 |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| 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: Blue Shield of California EPN |
$70.49
|
| Rate for Payer: Cash Price |
$59.40
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$26.40
|
| 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: United Healthcare All Other Commercial |
$49.84
|
| Rate for Payer: United Healthcare All Other HMO |
$48.68
|
| Rate for Payer: United Healthcare HMO Rider |
$47.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.56
|
|
|
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 |
$833.00 |
| Max. Negotiated Rate |
$2,142.00 |
| 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 |
$1,309.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,152.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,406.10
|
| Rate for Payer: Blue Distinction Transplant |
$1,428.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,785.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,294.72
|
| Rate for Payer: Cash Price |
$1,071.00
|
| Rate for Payer: Cash Price |
$1,071.00
|
| 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 Media |
$2,023.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,023.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,785.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$833.00
|
| 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: LLUH Dept of Risk Management WC |
$975.80
|
| 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 |
$1,190.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,190.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,190.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,190.00
|
| 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 |
905355848
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$2,142.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,270.92
|
| Rate for Payer: Cash Price |
$1,071.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$476.00
|
| 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: United Healthcare All Other Commercial |
$898.69
|
| Rate for Payer: United Healthcare All Other HMO |
$877.74
|
| Rate for Payer: United Healthcare HMO Rider |
$858.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$785.40
|
|
|
HC ADDL DIAG CD19
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Central Health Plan Commercial |
$332.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.00
|
| Rate for Payer: Galaxy Health WC |
$352.75
|
| Rate for Payer: Global Benefits Group Commercial |
$249.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$373.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$311.25
|
| Rate for Payer: Networks By Design Commercial |
$269.75
|
| Rate for Payer: Prime Health Services Commercial |
$352.75
|
|
|
HC ADDL DIAG CD19
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
903900103
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$327.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.60
|
| 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 |
$327.43
|
| Rate for Payer: Blue Distinction Transplant |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$88.99
|
| Rate for Payer: Blue Shield of California EPN |
$69.98
|
| Rate for Payer: Caremore Medicare Advantage |
$37.73
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.60
|
| Rate for Payer: Dignity Health Media |
$37.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.73
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: InnovAge PACE Commercial |
$56.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| 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 |
$28.80
|
| 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 |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| 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 |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$56.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
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: Blue Shield of California EPN |
$279.28
|
| Rate for Payer: Cash Price |
$235.35
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$104.60
|
| 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: United Healthcare All Other Commercial |
$197.48
|
| Rate for Payer: United Healthcare All Other HMO |
$192.88
|
| Rate for Payer: United Healthcare HMO Rider |
$188.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.59
|
|
|
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 |
$117.55 |
| Max. Negotiated Rate |
$470.70 |
| 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 |
$287.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$253.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.99
|
| Rate for Payer: Blue Distinction Transplant |
$313.80
|
| Rate for Payer: Blue Shield of California Commercial |
$392.25
|
| Rate for Payer: Blue Shield of California EPN |
$284.51
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| 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 Media |
$444.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$444.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$392.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.05
|
| 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: LLUH Dept of Risk Management WC |
$214.43
|
| 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 |
$261.50
|
| Rate for Payer: United Healthcare All Other HMO |
$261.50
|
| Rate for Payer: United Healthcare HMO Rider |
$261.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.50
|
| 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 |
905355681
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$1,863.90 |
| Rate for Payer: Blue Shield of California EPN |
$1,105.91
|
| Rate for Payer: Cash Price |
$931.95
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$414.20
|
| 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: United Healthcare All Other Commercial |
$782.01
|
| Rate for Payer: United Healthcare All Other HMO |
$763.78
|
| Rate for Payer: United Healthcare HMO Rider |
$747.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.43
|
|
|
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 |
$724.85 |
| Max. Negotiated Rate |
$1,863.90 |
| 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 |
$1,139.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,223.55
|
| Rate for Payer: Blue Distinction Transplant |
$1,242.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,553.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,126.62
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| 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 Media |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,553.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$724.85
|
| 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: LLUH Dept of Risk Management WC |
$849.11
|
| 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 |
$1,035.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.50
|
| 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 |
905355683
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$724.85 |
| Max. Negotiated Rate |
$1,863.90 |
| 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 |
$1,139.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,223.55
|
| Rate for Payer: Blue Distinction Transplant |
$1,242.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,553.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,126.62
|
| Rate for Payer: Cash Price |
$931.95
|
| Rate for Payer: Cash Price |
$931.95
|
| 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 Media |
$1,760.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,760.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,553.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$724.85
|
| 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: LLUH Dept of Risk Management WC |
$849.11
|
| 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 |
$1,035.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.50
|
| 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
|
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: Blue Shield of California EPN |
$1,105.91
|
| Rate for Payer: Cash Price |
$931.95
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$414.20
|
| 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: United Healthcare All Other Commercial |
$782.01
|
| Rate for Payer: United Healthcare All Other HMO |
$763.78
|
| Rate for Payer: United Healthcare HMO Rider |
$747.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.43
|
|
|
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: Blue Shield of California EPN |
$279.28
|
| Rate for Payer: Cash Price |
$235.35
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$104.60
|
| 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: United Healthcare All Other Commercial |
$197.48
|
| Rate for Payer: United Healthcare All Other HMO |
$192.88
|
| Rate for Payer: United Healthcare HMO Rider |
$188.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$172.59
|
|
