|
HC KNEE 1-2 VIEWS
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Central Health Plan Commercial |
$705.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$793.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$661.50
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
OP
|
$1,013.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$614.89
|
| Rate for Payer: Blue Shield of California EPN |
$402.16
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Central Health Plan Commercial |
$810.40
|
| Rate for Payer: Cigna of CA HMO |
$648.32
|
| Rate for Payer: Cigna of CA PPO |
$749.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
IP
|
$1,013.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.60 |
| Max. Negotiated Rate |
$911.70 |
| Rate for Payer: Adventist Health Commercial |
$202.60
|
| Rate for Payer: Cash Price |
$557.15
|
| Rate for Payer: Central Health Plan Commercial |
$810.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.20
|
| Rate for Payer: EPIC Health Plan Senior |
$405.20
|
| Rate for Payer: Galaxy Health WC |
$861.05
|
| Rate for Payer: Global Benefits Group Commercial |
$607.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$627.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.60
|
| Rate for Payer: Multiplan Commercial |
$759.75
|
| Rate for Payer: Networks By Design Commercial |
$658.45
|
| Rate for Payer: Prime Health Services Commercial |
$861.05
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$248.80 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$497.60
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$770.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.80
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$1,119.60 |
| Rate for Payer: Adventist Health Commercial |
$248.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$755.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.26
|
| Rate for Payer: Blue Shield of California Commercial |
$755.11
|
| Rate for Payer: Blue Shield of California EPN |
$493.87
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Cash Price |
$684.20
|
| Rate for Payer: Central Health Plan Commercial |
$995.20
|
| Rate for Payer: Cigna of CA HMO |
$796.16
|
| Rate for Payer: Cigna of CA PPO |
$920.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,057.40
|
| Rate for Payer: Global Benefits Group Commercial |
$746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,119.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$829.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$933.00
|
| Rate for Payer: Networks By Design Commercial |
$808.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,057.40
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$746.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
915352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Blue Shield of California Commercial |
$151.51
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
905352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Blue Shield of California Commercial |
$151.51
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
905352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.11
|
| Rate for Payer: Blue Shield of California Commercial |
$151.51
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.74
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
915352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.11
|
| Rate for Payer: Blue Shield of California Commercial |
$151.51
|
| Rate for Payer: Blue Shield of California EPN |
$98.78
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$137.20
|
| Rate for Payer: Cigna of CA PPO |
$137.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.74
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$98.00
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$73.56
|
| Rate for Payer: United Healthcare All Other HMO |
$71.60
|
| Rate for Payer: United Healthcare HMO Rider |
$70.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Adventist Health Commercial |
$169.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.55
|
| Rate for Payer: Blue Shield of California Commercial |
$319.25
|
| Rate for Payer: Blue Shield of California EPN |
$208.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: Cigna of CA HMO |
$289.10
|
| Rate for Payer: Cigna of CA PPO |
$289.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.70
|
| Rate for Payer: InnovAge PACE Commercial |
$206.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Networks By Design Commercial |
$206.50
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Riverside University Health System MISP |
$165.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.87
|
| Rate for Payer: United Healthcare HMO Rider |
$147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
915352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
915352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.70
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905352795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Blue Shield of California Commercial |
$319.25
|
| Rate for Payer: Blue Shield of California EPN |
$208.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: Cigna of CA HMO |
$289.10
|
| Rate for Payer: Cigna of CA PPO |
$289.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.60
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.87
|
| Rate for Payer: United Healthcare HMO Rider |
$147.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.26
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
IP
|
$487.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905362795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$438.30 |
| Rate for Payer: Adventist Health Commercial |
$97.40
|
| Rate for Payer: Blue Shield of California Commercial |
$376.45
|
| Rate for Payer: Blue Shield of California EPN |
$245.45
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: Cigna of CA HMO |
$340.90
|
| Rate for Payer: Cigna of CA PPO |
$340.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.40
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$316.55
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.77
|
| Rate for Payer: United Healthcare All Other HMO |
$177.90
|
| Rate for Payer: United Healthcare HMO Rider |
$174.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.49
|
|
|
HC KNEE CONTROL FULL KNEE CAP
|
Facility
|
OP
|
$487.00
|
|
|
Service Code
|
CPT L2795
|
| Hospital Charge Code |
905362795
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$438.30 |
| Rate for Payer: Adventist Health Commercial |
$199.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$413.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$267.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$286.02
|
| Rate for Payer: Blue Shield of California Commercial |
$376.45
|
| Rate for Payer: Blue Shield of California EPN |
$245.45
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Cash Price |
$267.85
|
| Rate for Payer: Central Health Plan Commercial |
$389.60
|
| Rate for Payer: Cigna of CA HMO |
$340.90
|
| Rate for Payer: Cigna of CA PPO |
$340.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$413.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$413.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$413.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.80
|
| Rate for Payer: EPIC Health Plan Senior |
$194.80
|
| Rate for Payer: Galaxy Health WC |
$413.95
|
| Rate for Payer: Global Benefits Group Commercial |
$292.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$438.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.70
|
| Rate for Payer: InnovAge PACE Commercial |
$243.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$340.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$340.90
|
| Rate for Payer: Multiplan Commercial |
$365.25
|
| Rate for Payer: Networks By Design Commercial |
$243.50
|
| Rate for Payer: Prime Health Services Commercial |
$413.95
|
| Rate for Payer: Riverside University Health System MISP |
$194.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.77
|
| Rate for Payer: United Healthcare All Other HMO |
$177.90
|
| Rate for Payer: United Healthcare HMO Rider |
$174.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$159.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$413.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$413.95
|
| Rate for Payer: Vantage Medical Group Senior |
$413.95
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
905352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.18 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Adventist Health Commercial |
$183.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.11
|
| Rate for Payer: Blue Shield of California Commercial |
$346.30
|
| Rate for Payer: Blue Shield of California EPN |
$225.79
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.18
|
| Rate for Payer: InnovAge PACE Commercial |
$224.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.60
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$224.00
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Riverside University Health System MISP |
$179.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$380.80
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
905352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Blue Shield of California Commercial |
$346.30
|
| Rate for Payer: Blue Shield of California EPN |
$225.79
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
915352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Adventist Health Commercial |
$89.60
|
| Rate for Payer: Blue Shield of California Commercial |
$346.30
|
| Rate for Payer: Blue Shield of California EPN |
$225.79
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$291.20
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
|
|
HC KNEE CONTROL MED/LAT CAP
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT L2800
|
| Hospital Charge Code |
915352800
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.18 |
| Max. Negotiated Rate |
$403.20 |
| Rate for Payer: Adventist Health Commercial |
$183.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$246.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.11
|
| Rate for Payer: Blue Shield of California Commercial |
$346.30
|
| Rate for Payer: Blue Shield of California EPN |
$225.79
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Central Health Plan Commercial |
$358.40
|
| Rate for Payer: Cigna of CA HMO |
$313.60
|
| Rate for Payer: Cigna of CA PPO |
$313.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$380.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Senior |
$179.20
|
| Rate for Payer: Galaxy Health WC |
$380.80
|
| Rate for Payer: Global Benefits Group Commercial |
$268.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$403.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.18
|
| Rate for Payer: InnovAge PACE Commercial |
$224.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$298.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$277.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$313.60
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$224.00
|
| Rate for Payer: Prime Health Services Commercial |
$380.80
|
| Rate for Payer: Riverside University Health System MISP |
$179.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$268.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$268.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.13
|
| Rate for Payer: United Healthcare All Other HMO |
$163.65
|
| Rate for Payer: United Healthcare HMO Rider |
$160.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$146.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$380.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$380.80
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
IP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
915355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$9,203.74 |
| Rate for Payer: Adventist Health Commercial |
$2,045.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,904.99
|
| Rate for Payer: Blue Shield of California EPN |
$5,154.10
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Central Health Plan Commercial |
$8,181.10
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,203.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,896.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.28
|
| Rate for Payer: Multiplan Commercial |
$7,669.78
|
| Rate for Payer: Networks By Design Commercial |
$6,647.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
OP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
915355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,349.14 |
| Max. Negotiated Rate |
$9,203.74 |
| Rate for Payer: Adventist Health Commercial |
$4,192.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,624.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,669.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,005.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,904.99
|
| Rate for Payer: Blue Shield of California EPN |
$5,154.10
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Central Health Plan Commercial |
$8,181.10
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,692.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,692.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,203.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,002.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5,113.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,526.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,192.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,158.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,158.47
|
| Rate for Payer: Multiplan Commercial |
$7,669.78
|
| Rate for Payer: Networks By Design Commercial |
$5,113.19
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: Riverside University Health System MISP |
$4,090.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,135.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,135.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8,692.42
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
OP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
905355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,349.14 |
| Max. Negotiated Rate |
$9,203.74 |
| Rate for Payer: Adventist Health Commercial |
$4,192.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,624.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,669.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,005.95
|
| Rate for Payer: Blue Shield of California Commercial |
$7,904.99
|
| Rate for Payer: Blue Shield of California EPN |
$5,154.10
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Central Health Plan Commercial |
$8,181.10
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,692.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,692.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,203.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5,002.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5,113.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,526.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,192.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,158.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,158.47
|
| Rate for Payer: Multiplan Commercial |
$7,669.78
|
| Rate for Payer: Networks By Design Commercial |
$5,113.19
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: Riverside University Health System MISP |
$4,090.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,135.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,135.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8,692.42
|
|
|
HC KNEE DISARTIC, SACH FT, ENDO
|
Facility
|
IP
|
$10,226.38
|
|
|
Service Code
|
CPT L5312
|
| Hospital Charge Code |
905355312
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,045.28 |
| Max. Negotiated Rate |
$9,203.74 |
| Rate for Payer: Adventist Health Commercial |
$2,045.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,904.99
|
| Rate for Payer: Blue Shield of California EPN |
$5,154.10
|
| Rate for Payer: Cash Price |
$5,624.51
|
| Rate for Payer: Central Health Plan Commercial |
$8,181.10
|
| Rate for Payer: Cigna of CA HMO |
$7,158.47
|
| Rate for Payer: Cigna of CA PPO |
$7,158.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Senior |
$4,090.55
|
| Rate for Payer: Galaxy Health WC |
$8,692.42
|
| Rate for Payer: Global Benefits Group Commercial |
$6,135.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,203.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,821.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,896.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,330.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,045.28
|
| Rate for Payer: Multiplan Commercial |
$7,669.78
|
| Rate for Payer: Networks By Design Commercial |
$6,647.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,692.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,837.96
|
| Rate for Payer: United Healthcare All Other HMO |
$3,735.70
|
| Rate for Payer: United Healthcare HMO Rider |
$3,654.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,349.14
|
|
|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
IP
|
$59,940.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
905355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11,988.00 |
| Max. Negotiated Rate |
$53,946.00 |
| Rate for Payer: Adventist Health Commercial |
$11,988.00
|
| Rate for Payer: Blue Shield of California Commercial |
$46,333.62
|
| Rate for Payer: Blue Shield of California EPN |
$30,209.76
|
| Rate for Payer: Cash Price |
$32,967.00
|
| Rate for Payer: Central Health Plan Commercial |
$47,952.00
|
| Rate for Payer: Cigna of CA HMO |
$41,958.00
|
| Rate for Payer: Cigna of CA PPO |
$41,958.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,976.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23,976.00
|
| Rate for Payer: Galaxy Health WC |
$50,949.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35,964.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,946.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,979.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22,837.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,102.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,988.00
|
| Rate for Payer: Multiplan Commercial |
$44,955.00
|
| Rate for Payer: Networks By Design Commercial |
$38,961.00
|
| Rate for Payer: Prime Health Services Commercial |
$50,949.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,495.48
|
| Rate for Payer: United Healthcare All Other HMO |
$21,896.08
|
| Rate for Payer: United Healthcare HMO Rider |
$21,422.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,630.35
|
|
|
HC KNEE-SHIN PRO FLEX/EXT CONT
|
Facility
|
OP
|
$59,940.00
|
|
|
Service Code
|
CPT L5859
|
| Hospital Charge Code |
905355859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19,630.35 |
| Max. Negotiated Rate |
$53,946.00 |
| Rate for Payer: Adventist Health Commercial |
$24,575.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50,949.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32,967.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44,955.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,202.76
|
| Rate for Payer: Blue Shield of California Commercial |
$46,333.62
|
| Rate for Payer: Blue Shield of California EPN |
$30,209.76
|
| Rate for Payer: Cash Price |
$32,967.00
|
| Rate for Payer: Central Health Plan Commercial |
$47,952.00
|
| Rate for Payer: Cigna of CA HMO |
$41,958.00
|
| Rate for Payer: Cigna of CA PPO |
$41,958.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50,949.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,949.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50,949.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,976.00
|
| Rate for Payer: EPIC Health Plan Senior |
$23,976.00
|
| Rate for Payer: Galaxy Health WC |
$50,949.00
|
| Rate for Payer: Global Benefits Group Commercial |
$35,964.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$53,946.00
|
| Rate for Payer: InnovAge PACE Commercial |
$29,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,979.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37,102.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,575.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41,958.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41,958.00
|
| Rate for Payer: Multiplan Commercial |
$44,955.00
|
| Rate for Payer: Networks By Design Commercial |
$29,970.00
|
| Rate for Payer: Prime Health Services Commercial |
$50,949.00
|
| Rate for Payer: Riverside University Health System MISP |
$23,976.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35,964.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35,964.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,495.48
|
| Rate for Payer: United Healthcare All Other HMO |
$21,896.08
|
| Rate for Payer: United Healthcare HMO Rider |
$21,422.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,630.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50,949.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,949.00
|
| Rate for Payer: Vantage Medical Group Senior |
$50,949.00
|
|
