|
HC ADD. LE FOOT LAMIN/PREPREG COMPOSIT
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT L3031
|
| Hospital Charge Code |
905353031
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.05 |
| 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: 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 |
$199.26
|
| 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 PROS VACUUM PUMP VLM MG
|
Facility
|
IP
|
$6,750.00
|
|
|
Service Code
|
CPT L5781
|
| Hospital Charge Code |
905355781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Blue Shield of California EPN |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,571.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.00
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,548.80
|
| Rate for Payer: United Healthcare All Other HMO |
$2,489.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,435.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,227.50
|
|
|
HC ADD/LE PROS VACUUM PUMP VLM MG
|
Facility
|
OP
|
$6,750.00
|
|
|
Service Code
|
CPT L5781
|
| Hospital Charge Code |
905355781
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,362.50 |
| Max. Negotiated Rate |
$6,075.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,712.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,712.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,268.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,987.90
|
| Rate for Payer: Blue Distinction Transplant |
$4,050.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,062.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,672.00
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Cash Price |
$3,037.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,400.00
|
| Rate for Payer: Cigna of CA HMO |
$4,725.00
|
| Rate for Payer: Cigna of CA PPO |
$4,725.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,737.50
|
| Rate for Payer: Dignity Health Media |
$5,737.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,737.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,700.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,700.00
|
| Rate for Payer: Galaxy Health WC |
$5,737.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,050.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,075.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,062.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,502.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,788.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,767.50
|
| Rate for Payer: Multiplan Commercial |
$5,062.50
|
| Rate for Payer: Networks By Design Commercial |
$3,375.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,737.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,700.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,050.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,050.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,375.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,375.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,737.50
|
| Rate for Payer: Vantage Medical Group Senior |
$5,737.50
|
|
|
HC ADD LE SILICONE INSERT NO LOCK
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
905355679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Blue Shield of California EPN |
$599.15
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.40
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.67
|
| Rate for Payer: United Healthcare All Other HMO |
$413.79
|
| Rate for Payer: United Healthcare HMO Rider |
$404.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.26
|
|
|
HC ADD LE SILICONE INSERT NO LOCK
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT L5679
|
| Hospital Charge Code |
905355679
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$617.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$543.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$662.88
|
| Rate for Payer: Blue Distinction Transplant |
$673.20
|
| Rate for Payer: Blue Shield of California Commercial |
$841.50
|
| Rate for Payer: Blue Shield of California EPN |
$610.37
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$953.70
|
| Rate for Payer: Dignity Health Media |
$953.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$841.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$392.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.02
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: Riverside University Health System MISP |
$448.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$561.00
|
| Rate for Payer: United Healthcare All Other HMO |
$561.00
|
| Rate for Payer: United Healthcare HMO Rider |
$561.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$561.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$953.70
|
| Rate for Payer: Vantage Medical Group Senior |
$953.70
|
|
|
HC ADD LE SILICONE INSERT W/LOCK
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
905355673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Blue Shield of California EPN |
$718.76
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$508.25
|
| Rate for Payer: United Healthcare All Other HMO |
$496.40
|
| Rate for Payer: United Healthcare HMO Rider |
$485.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.18
|
|
|
HC ADD LE SILICONE INSERT W/LOCK
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
CPT L5673
|
| Hospital Charge Code |
905355673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$471.10 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$740.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$740.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.22
|
| Rate for Payer: Blue Distinction Transplant |
$807.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,009.50
|
| Rate for Payer: Blue Shield of California EPN |
$732.22
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$942.20
|
| Rate for Payer: Cigna of CA PPO |
$942.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.10
|
| Rate for Payer: Dignity Health Media |
$1,144.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,144.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,009.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$471.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.86
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$673.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Riverside University Health System MISP |
$538.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$673.00
|
| Rate for Payer: United Healthcare HMO Rider |
$673.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$673.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.10
|
|
|
HC ADDL PMP NW SUBC THER INF SITE
|
Facility
|
IP
|
$294.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
907296371
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$264.60 |
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.60
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
|
|
HC ADDL PMP NW SUBC THER INF SITE
|
Facility
|
OP
|
$294.00
|
|
|
Service Code
|
CPT 96371
|
| Hospital Charge Code |
907296371
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$88.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$903.00
|
| Rate for Payer: Blue Distinction Transplant |
$176.40
|
| Rate for Payer: Caremore Medicare Advantage |
$88.02
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Central Health Plan Commercial |
$235.20
|
| Rate for Payer: Cigna of CA HMO |
$188.16
|
| Rate for Payer: Cigna of CA PPO |
$217.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.03
|
| Rate for Payer: Dignity Health Media |
$88.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$88.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.02
|
| Rate for Payer: Galaxy Health WC |
$249.90
|
| Rate for Payer: Global Benefits Group Commercial |
$176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$264.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$220.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$144.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$145.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$88.02
|
| Rate for Payer: InnovAge PACE Commercial |
$132.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.95
|
| Rate for Payer: Multiplan Commercial |
$220.50
|
| Rate for Payer: Networks By Design Commercial |
$191.10
|
| Rate for Payer: Prime Health Services Commercial |
$249.90
|
| Rate for Payer: Prime Health Services Medicare |
$93.30
|
| Rate for Payer: Riverside University Health System MISP |
$96.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$176.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.82
|
| Rate for Payer: Vantage Medical Group Senior |
$88.02
|
|
|
HC ADDN ENDO KNEE/SHIN HYDRAULIC
|
Facility
|
OP
|
$6,265.00
|
|
|
Service Code
|
CPT L5814
|
| Hospital Charge Code |
905355814
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,192.75 |
| Max. Negotiated Rate |
$5,638.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,445.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,445.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,033.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,701.36
|
| Rate for Payer: Blue Distinction Transplant |
$3,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,698.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,408.16
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,012.00
|
| Rate for Payer: Cigna of CA HMO |
$4,385.50
|
| Rate for Payer: Cigna of CA PPO |
$4,385.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.25
|
| Rate for Payer: Dignity Health Media |
$5,325.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,325.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,506.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,506.00
|
| Rate for Payer: Galaxy Health WC |
$5,325.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,638.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,698.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,192.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,083.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,568.65
|
| Rate for Payer: Multiplan Commercial |
$4,698.75
|
| Rate for Payer: Networks By Design Commercial |
$3,132.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,325.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,132.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,325.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5,325.25
|
|
|
HC ADDN ENDO KNEE/SHIN HYDRAULIC
|
Facility
|
IP
|
$6,265.00
|
|
|
Service Code
|
CPT L5814
|
| Hospital Charge Code |
905355814
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,253.00 |
| Max. Negotiated Rate |
$5,638.50 |
| Rate for Payer: Blue Shield of California EPN |
$3,345.51
|
| Rate for Payer: Cash Price |
$2,819.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,012.00
|
| Rate for Payer: Cigna of CA HMO |
$4,385.50
|
| Rate for Payer: Cigna of CA PPO |
$4,385.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,506.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,506.00
|
| Rate for Payer: Galaxy Health WC |
$5,325.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,638.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,386.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,253.00
|
| Rate for Payer: Multiplan Commercial |
$4,698.75
|
| Rate for Payer: Networks By Design Commercial |
$3,132.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,325.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,365.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2,310.53
|
| Rate for Payer: United Healthcare HMO Rider |
$2,260.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,067.45
|
|
|
HC ADDN LE VERTICAL LOADING PYLON
|
Facility
|
OP
|
$2,171.00
|
|
|
Service Code
|
CPT L5988
|
| Hospital Charge Code |
905355988
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$759.85 |
| Max. Negotiated Rate |
$1,953.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,194.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,194.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,051.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,282.63
|
| Rate for Payer: Blue Distinction Transplant |
$1,302.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,628.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,181.02
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,736.80
|
| Rate for Payer: Cigna of CA HMO |
$1,519.70
|
| Rate for Payer: Cigna of CA PPO |
$1,519.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,845.35
|
| Rate for Payer: Dignity Health Media |
$1,845.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,845.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$868.40
|
| Rate for Payer: Galaxy Health WC |
$1,845.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,302.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,953.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,628.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$759.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,696.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.11
|
| Rate for Payer: Multiplan Commercial |
$1,628.25
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,845.35
|
| Rate for Payer: Riverside University Health System MISP |
$868.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,302.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,302.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,085.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,085.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,085.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,845.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,845.35
|
|
|
HC ADDN LE VERTICAL LOADING PYLON
|
Facility
|
IP
|
$2,171.00
|
|
|
Service Code
|
CPT L5988
|
| Hospital Charge Code |
905355988
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$434.20 |
| Max. Negotiated Rate |
$1,953.90 |
| Rate for Payer: Blue Shield of California EPN |
$1,159.31
|
| Rate for Payer: Cash Price |
$976.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,736.80
|
| Rate for Payer: Cigna of CA HMO |
$1,519.70
|
| Rate for Payer: Cigna of CA PPO |
$1,519.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$868.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$868.40
|
| Rate for Payer: Galaxy Health WC |
$1,845.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,302.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,953.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,448.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$827.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.20
|
| Rate for Payer: Multiplan Commercial |
$1,628.25
|
| Rate for Payer: Networks By Design Commercial |
$1,085.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,845.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$819.77
|
| Rate for Payer: United Healthcare All Other HMO |
$800.66
|
| Rate for Payer: United Healthcare HMO Rider |
$783.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$716.43
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
OP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$627.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$551.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$673.51
|
| Rate for Payer: Blue Distinction Transplant |
$684.00
|
| Rate for Payer: Blue Shield of California Commercial |
$855.00
|
| Rate for Payer: Blue Shield of California EPN |
$620.16
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Central Health Plan Commercial |
$912.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Media |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$855.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$399.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$808.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$467.40
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: Networks By Design Commercial |
$570.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Riverside University Health System MISP |
$456.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$570.00
|
| Rate for Payer: United Healthcare HMO Rider |
$570.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC ADDN TO LE, LOCK MECH/LANYARD
|
Facility
|
IP
|
$1,140.00
|
|
|
Service Code
|
CPT L5671
|
| Hospital Charge Code |
905355671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$1,026.00 |
| Rate for Payer: Blue Shield of California EPN |
$608.76
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Central Health Plan Commercial |
$912.00
|
| Rate for Payer: Cigna of CA HMO |
$798.00
|
| Rate for Payer: Cigna of CA PPO |
$798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,026.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.00
|
| Rate for Payer: Multiplan Commercial |
$855.00
|
| Rate for Payer: Networks By Design Commercial |
$570.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$430.46
|
| Rate for Payer: United Healthcare All Other HMO |
$420.43
|
| Rate for Payer: United Healthcare HMO Rider |
$411.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$376.20
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
OP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
905355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$437.85 |
| Max. Negotiated Rate |
$1,125.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$688.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$688.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$605.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$739.09
|
| Rate for Payer: Blue Distinction Transplant |
$750.60
|
| Rate for Payer: Blue Shield of California Commercial |
$938.25
|
| Rate for Payer: Blue Shield of California EPN |
$680.54
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,063.35
|
| Rate for Payer: Dignity Health Media |
$1,063.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,063.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$938.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$437.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.91
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$625.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: Riverside University Health System MISP |
$500.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$750.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$625.50
|
| Rate for Payer: United Healthcare All Other HMO |
$625.50
|
| Rate for Payer: United Healthcare HMO Rider |
$625.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,063.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,063.35
|
|
|
HC ADDN TO LE, QUICK CHNG SELF-AL
|
Facility
|
IP
|
$1,251.00
|
|
|
Service Code
|
CPT L5617
|
| Hospital Charge Code |
905355617
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.20 |
| Max. Negotiated Rate |
$1,125.90 |
| Rate for Payer: Blue Shield of California EPN |
$668.03
|
| Rate for Payer: Cash Price |
$562.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$875.70
|
| Rate for Payer: Cigna of CA PPO |
$875.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$500.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$500.40
|
| Rate for Payer: Galaxy Health WC |
$1,063.35
|
| Rate for Payer: Global Benefits Group Commercial |
$750.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,125.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$834.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.20
|
| Rate for Payer: Multiplan Commercial |
$938.25
|
| Rate for Payer: Networks By Design Commercial |
$625.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,063.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.38
|
| Rate for Payer: United Healthcare All Other HMO |
$461.37
|
| Rate for Payer: United Healthcare HMO Rider |
$451.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$412.83
|
|
|
HC ADD SHEATH AIR SEAL SUCTION
|
Facility
|
IP
|
$478.00
|
|
| Hospital Charge Code |
905358490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Blue Shield of California EPN |
$255.25
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.60
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.49
|
| Rate for Payer: United Healthcare All Other HMO |
$176.29
|
| Rate for Payer: United Healthcare HMO Rider |
$172.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.74
|
|
|
HC ADD SHEATH AIR SEAL SUCTION
|
Facility
|
OP
|
$478.00
|
|
| Hospital Charge Code |
905358490
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$430.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$406.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.40
|
| Rate for Payer: Blue Distinction Transplant |
$286.80
|
| Rate for Payer: Blue Shield of California Commercial |
$358.50
|
| Rate for Payer: Blue Shield of California EPN |
$260.03
|
| Rate for Payer: Cash Price |
$215.10
|
| Rate for Payer: Central Health Plan Commercial |
$382.40
|
| Rate for Payer: Cigna of CA HMO |
$334.60
|
| Rate for Payer: Cigna of CA PPO |
$334.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$406.30
|
| Rate for Payer: Dignity Health Media |
$406.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$406.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$191.20
|
| Rate for Payer: Galaxy Health WC |
$406.30
|
| Rate for Payer: Global Benefits Group Commercial |
$286.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$430.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$358.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.98
|
| Rate for Payer: Multiplan Commercial |
$358.50
|
| Rate for Payer: Networks By Design Commercial |
$239.00
|
| Rate for Payer: Prime Health Services Commercial |
$406.30
|
| Rate for Payer: Riverside University Health System MISP |
$191.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$239.00
|
| Rate for Payer: United Healthcare All Other HMO |
$239.00
|
| Rate for Payer: United Healthcare HMO Rider |
$239.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$239.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$406.30
|
| Rate for Payer: Vantage Medical Group Senior |
$406.30
|
|
|
HC ADD TO LE ULTRAFLEX KNEE/ANKLE
|
Facility
|
IP
|
$657.00
|
|
| Hospital Charge Code |
905352860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Blue Shield of California EPN |
$350.84
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.40
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.08
|
| Rate for Payer: United Healthcare All Other HMO |
$242.30
|
| Rate for Payer: United Healthcare HMO Rider |
$237.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
|
|
HC ADD TO LE ULTRAFLEX KNEE/ANKLE
|
Facility
|
OP
|
$657.00
|
|
| Hospital Charge Code |
905352860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.95 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$318.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.16
|
| Rate for Payer: Blue Distinction Transplant |
$394.20
|
| Rate for Payer: Blue Shield of California Commercial |
$492.75
|
| Rate for Payer: Blue Shield of California EPN |
$357.41
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.45
|
| Rate for Payer: Dignity Health Media |
$558.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$492.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$229.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.37
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Riverside University Health System MISP |
$262.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.50
|
| Rate for Payer: United Healthcare All Other HMO |
$328.50
|
| Rate for Payer: United Healthcare HMO Rider |
$328.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.45
|
| Rate for Payer: Vantage Medical Group Senior |
$558.45
|
|
|
HC ADD UE PROST A/E ACRYLIC
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT L7404
|
| Hospital Charge Code |
905357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Blue Shield of California EPN |
$584.73
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$766.50
|
| Rate for Payer: Cigna of CA PPO |
$766.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$547.50
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.47
|
| Rate for Payer: United Healthcare All Other HMO |
$403.84
|
| Rate for Payer: United Healthcare HMO Rider |
$395.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.35
|
|
|
HC ADD UE PROST A/E ACRYLIC
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT L7404
|
| Hospital Charge Code |
905357404
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.25 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$602.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$530.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.93
|
| Rate for Payer: Blue Distinction Transplant |
$657.00
|
| Rate for Payer: Blue Shield of California Commercial |
$821.25
|
| Rate for Payer: Blue Shield of California EPN |
$595.68
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Central Health Plan Commercial |
$876.00
|
| Rate for Payer: Cigna of CA HMO |
$766.50
|
| Rate for Payer: Cigna of CA PPO |
$766.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Media |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$985.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$821.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$383.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.95
|
| Rate for Payer: Multiplan Commercial |
$821.25
|
| Rate for Payer: Networks By Design Commercial |
$547.50
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Riverside University Health System MISP |
$438.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$547.50
|
| Rate for Payer: United Healthcare All Other HMO |
$547.50
|
| Rate for Payer: United Healthcare HMO Rider |
$547.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$547.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC ADD UE PROST A/E ULTILITE MAT
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT L7401
|
| Hospital Charge Code |
905357401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Blue Shield of California EPN |
$301.71
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Central Health Plan Commercial |
$452.00
|
| Rate for Payer: Cigna of CA HMO |
$395.50
|
| Rate for Payer: Cigna of CA PPO |
$395.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$508.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: Networks By Design Commercial |
$282.50
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.34
|
| Rate for Payer: United Healthcare All Other HMO |
$208.37
|
| Rate for Payer: United Healthcare HMO Rider |
$203.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.45
|
|
|
HC ADD UE PROST A/E ULTILITE MAT
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT L7401
|
| Hospital Charge Code |
905357401
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$197.75 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.80
|
| Rate for Payer: Blue Distinction Transplant |
$339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$423.75
|
| Rate for Payer: Blue Shield of California EPN |
$307.36
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Central Health Plan Commercial |
$452.00
|
| Rate for Payer: Cigna of CA HMO |
$395.50
|
| Rate for Payer: Cigna of CA PPO |
$395.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Media |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$508.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$423.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: Networks By Design Commercial |
$282.50
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Riverside University Health System MISP |
$226.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$339.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.50
|
| Rate for Payer: United Healthcare All Other HMO |
$282.50
|
| Rate for Payer: United Healthcare HMO Rider |
$282.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
