|
HC HFO W/JOINT(S) CF
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT L3921
|
| Hospital Charge Code |
905353921
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.20 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Adventist Health Commercial |
$196.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$264.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$360.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$281.90
|
| Rate for Payer: Blue Shield of California Commercial |
$371.04
|
| Rate for Payer: Blue Shield of California EPN |
$241.92
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$336.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$408.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$408.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: EPIC Health Plan Senior |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.08
|
| Rate for Payer: InnovAge PACE Commercial |
$240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$336.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$240.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
| Rate for Payer: Riverside University Health System MISP |
$192.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$180.14
|
| Rate for Payer: United Healthcare All Other HMO |
$175.34
|
| Rate for Payer: United Healthcare HMO Rider |
$171.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$408.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$408.00
|
| Rate for Payer: Vantage Medical Group Senior |
$408.00
|
|
|
HC HFO WO JOINT PF
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$108.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$155.05
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$224.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.29
|
| Rate for Payer: InnovAge PACE Commercial |
$132.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$132.00
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: Riverside University Health System MISP |
$105.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$158.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$158.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Vantage Medical Group Senior |
$224.40
|
|
|
HC HFO WO JOINT PF
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT L3923
|
| Hospital Charge Code |
903203954
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$237.60 |
| Rate for Payer: Adventist Health Commercial |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$204.07
|
| Rate for Payer: Blue Shield of California EPN |
$133.06
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$211.20
|
| Rate for Payer: Cigna of CA HMO |
$184.80
|
| Rate for Payer: Cigna of CA PPO |
$184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Senior |
$105.60
|
| Rate for Payer: Galaxy Health WC |
$224.40
|
| Rate for Payer: Global Benefits Group Commercial |
$158.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$237.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.80
|
| Rate for Payer: Multiplan Commercial |
$198.00
|
| Rate for Payer: Networks By Design Commercial |
$171.60
|
| Rate for Payer: Prime Health Services Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.08
|
| Rate for Payer: United Healthcare All Other HMO |
$96.44
|
| Rate for Payer: United Healthcare HMO Rider |
$94.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.46
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
915353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.86
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.51
|
| Rate for Payer: InnovAge PACE Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
905353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$132.64 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.86
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$266.51
|
| Rate for Payer: InnovAge PACE Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Riverside University Health System MISP |
$162.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HFO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3913
|
| Hospital Charge Code |
915353913
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$364.50 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Blue Shield of California Commercial |
$313.06
|
| Rate for Payer: Blue Shield of California EPN |
$204.12
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Central Health Plan Commercial |
$324.00
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$364.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.00
|
| Rate for Payer: Multiplan Commercial |
$303.75
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,529.47 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$5,244.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,035.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,512.74
|
| Rate for Payer: Blue Shield of California Commercial |
$9,888.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,873.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,873.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,529.47
|
| Rate for Payer: InnovAge PACE Commercial |
$6,396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,244.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,954.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,954.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: Riverside University Health System MISP |
$5,116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,675.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,675.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,873.20
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
905355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,558.40 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$2,558.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9,888.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,873.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$8,314.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
OP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
915355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,529.47 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$5,244.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,035.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,512.74
|
| Rate for Payer: Blue Shield of California Commercial |
$9,888.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,873.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,873.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,529.47
|
| Rate for Payer: InnovAge PACE Commercial |
$6,396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,794.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,244.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,954.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,954.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$6,396.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: Riverside University Health System MISP |
$5,116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,675.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,675.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,873.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10,873.20
|
|
|
HC HIGH ACTIVITY KNEE CNTRL FRAME
|
Facility
|
IP
|
$12,792.00
|
|
|
Service Code
|
CPT L5930
|
| Hospital Charge Code |
915355930
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,558.40 |
| Max. Negotiated Rate |
$11,512.80 |
| Rate for Payer: Adventist Health Commercial |
$2,558.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9,888.22
|
| Rate for Payer: Blue Shield of California EPN |
$6,447.17
|
| Rate for Payer: Cash Price |
$5,756.40
|
| Rate for Payer: Central Health Plan Commercial |
$10,233.60
|
| Rate for Payer: Cigna of CA HMO |
$8,954.40
|
| Rate for Payer: Cigna of CA PPO |
$8,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,116.80
|
| Rate for Payer: Galaxy Health WC |
$10,873.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,675.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,512.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,532.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,873.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,918.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,558.40
|
| Rate for Payer: Multiplan Commercial |
$9,594.00
|
| Rate for Payer: Networks By Design Commercial |
$8,314.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,873.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,800.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4,672.92
|
| Rate for Payer: United Healthcare HMO Rider |
$4,571.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.38
|
|
|
HC HIGH FLOW 02
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC HIGH FLOW 02
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800912
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$227.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.03
|
| Rate for Payer: Blue Shield of California Commercial |
$285.29
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
IP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,097.20 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,194.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,194.40
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,994.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,995.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,490.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
|
|
HC HIGH FREQUENCY VENT INTL DAILY
|
Facility
|
OP
|
$10,486.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
900800015
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.06 |
| Max. Negotiated Rate |
$9,437.40 |
| Rate for Payer: Adventist Health Commercial |
$2,097.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$839.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,368.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Cash Price |
$4,718.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,388.80
|
| Rate for Payer: Cigna of CA HMO |
$6,711.04
|
| Rate for Payer: Cigna of CA PPO |
$7,759.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$8,913.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,291.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,437.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: InnovAge PACE Commercial |
$1,259.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,994.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,097.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,125.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$7,864.50
|
| Rate for Payer: Networks By Design Commercial |
$6,815.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$839.99
|
| Rate for Payer: Prime Health Services Commercial |
$8,913.10
|
| Rate for Payer: Prime Health Services Medicare |
$890.39
|
| Rate for Payer: Riverside University Health System MISP |
$923.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,291.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,291.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
IP
|
$8,348.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,669.60 |
| Max. Negotiated Rate |
$7,513.20 |
| Rate for Payer: Adventist Health Commercial |
$1,669.60
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,678.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,339.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,339.20
|
| Rate for Payer: Galaxy Health WC |
$7,095.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,008.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,513.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,568.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,180.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,167.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.60
|
| Rate for Payer: Multiplan Commercial |
$6,261.00
|
| Rate for Payer: Networks By Design Commercial |
$5,426.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,095.80
|
|
|
HC HIGH FREQUENCY VENT SUB
|
Facility
|
OP
|
$8,348.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
900800016
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$60.72 |
| Max. Negotiated Rate |
$7,513.20 |
| Rate for Payer: Adventist Health Commercial |
$1,669.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$839.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,069.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$839.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Cash Price |
$3,756.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,678.40
|
| Rate for Payer: Cigna of CA HMO |
$5,342.72
|
| Rate for Payer: Cigna of CA PPO |
$6,177.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$839.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,133.99
|
| Rate for Payer: EPIC Health Plan Senior |
$839.99
|
| Rate for Payer: Galaxy Health WC |
$7,095.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,008.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,513.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,377.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$839.99
|
| Rate for Payer: InnovAge PACE Commercial |
$1,259.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,568.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,669.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,125.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,125.59
|
| Rate for Payer: Multiplan Commercial |
$6,261.00
|
| Rate for Payer: Networks By Design Commercial |
$5,426.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$839.99
|
| Rate for Payer: Prime Health Services Commercial |
$7,095.80
|
| Rate for Payer: Prime Health Services Medicare |
$890.39
|
| Rate for Payer: Riverside University Health System MISP |
$923.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,008.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,008.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$839.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,259.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.99
|
| Rate for Payer: Vantage Medical Group Senior |
$839.99
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
915352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Blue Shield of California Commercial |
$527.96
|
| Rate for Payer: Blue Shield of California EPN |
$344.23
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.60
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$443.95
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
915352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.68 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Adventist Health Commercial |
$280.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$512.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$401.13
|
| Rate for Payer: Blue Shield of California Commercial |
$527.96
|
| Rate for Payer: Blue Shield of California EPN |
$344.23
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$580.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$580.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$580.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.19
|
| Rate for Payer: InnovAge PACE Commercial |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.10
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: Riverside University Health System MISP |
$273.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$580.55
|
| Rate for Payer: Vantage Medical Group Senior |
$580.55
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
OP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
905352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$223.68 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Adventist Health Commercial |
$280.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$375.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$512.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$401.13
|
| Rate for Payer: Blue Shield of California Commercial |
$527.96
|
| Rate for Payer: Blue Shield of California EPN |
$344.23
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$580.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$580.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$580.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$295.19
|
| Rate for Payer: InnovAge PACE Commercial |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.10
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$341.50
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: Riverside University Health System MISP |
$273.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$580.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$580.55
|
| Rate for Payer: Vantage Medical Group Senior |
$580.55
|
|
|
HC HIGH ROLL CUFF ADD. KAFO
|
Facility
|
IP
|
$683.00
|
|
|
Service Code
|
CPT L2550
|
| Hospital Charge Code |
905352550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$136.60 |
| Max. Negotiated Rate |
$614.70 |
| Rate for Payer: Adventist Health Commercial |
$136.60
|
| Rate for Payer: Blue Shield of California Commercial |
$527.96
|
| Rate for Payer: Blue Shield of California EPN |
$344.23
|
| Rate for Payer: Cash Price |
$307.35
|
| Rate for Payer: Central Health Plan Commercial |
$546.40
|
| Rate for Payer: Cigna of CA HMO |
$478.10
|
| Rate for Payer: Cigna of CA PPO |
$478.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.20
|
| Rate for Payer: EPIC Health Plan Senior |
$273.20
|
| Rate for Payer: Galaxy Health WC |
$580.55
|
| Rate for Payer: Global Benefits Group Commercial |
$409.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$614.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$455.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.60
|
| Rate for Payer: Multiplan Commercial |
$512.25
|
| Rate for Payer: Networks By Design Commercial |
$443.95
|
| Rate for Payer: Prime Health Services Commercial |
$580.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$256.33
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$223.68
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$553.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$488.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: Cigna of CA HMO |
$416.64
|
| Rate for Payer: Cigna of CA PPO |
$481.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$553.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$553.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$553.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.43
|
| Rate for Payer: InnovAge PACE Commercial |
$325.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$455.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.70
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
| Rate for Payer: Riverside University Health System MISP |
$260.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$553.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$553.35
|
| Rate for Payer: Vantage Medical Group Senior |
$553.35
|
|
|
HC HIP ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
909000116
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$585.90 |
| Rate for Payer: Adventist Health Commercial |
$130.20
|
| Rate for Payer: Cash Price |
$292.95
|
| Rate for Payer: Central Health Plan Commercial |
$520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$260.40
|
| Rate for Payer: Galaxy Health WC |
$553.35
|
| Rate for Payer: Global Benefits Group Commercial |
$390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.20
|
| Rate for Payer: Multiplan Commercial |
$488.25
|
| Rate for Payer: Networks By Design Commercial |
$423.15
|
| Rate for Payer: Prime Health Services Commercial |
$553.35
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
915352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.60 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Blue Shield of California Commercial |
$852.62
|
| Rate for Payer: Blue Shield of California EPN |
$555.91
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.60
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Networks By Design Commercial |
$716.95
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.96
|
| Rate for Payer: United Healthcare All Other HMO |
$402.93
|
| Rate for Payer: United Healthcare HMO Rider |
$394.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.23
|
|
|
HC HIP JT ADJ FLEX EXT ABD
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT L2624
|
| Hospital Charge Code |
915352624
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.23 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Adventist Health Commercial |
$452.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$937.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$606.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$827.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.79
|
| Rate for Payer: Blue Shield of California Commercial |
$852.62
|
| Rate for Payer: Blue Shield of California EPN |
$555.91
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Cigna of CA HMO |
$772.10
|
| Rate for Payer: Cigna of CA PPO |
$772.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$937.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$937.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$937.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$457.33
|
| Rate for Payer: InnovAge PACE Commercial |
$551.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$772.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$772.10
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Networks By Design Commercial |
$551.50
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: Riverside University Health System MISP |
$441.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$413.96
|
| Rate for Payer: United Healthcare All Other HMO |
$402.93
|
| Rate for Payer: United Healthcare HMO Rider |
$394.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$361.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$937.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$937.55
|
| Rate for Payer: Vantage Medical Group Senior |
$937.55
|
|
