|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.83
|
| Rate for Payer: Blue Distinction Transplant |
$672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$692.16
|
| Rate for Payer: Blue Shield of California EPN |
$544.32
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Central Health Plan Commercial |
$896.00
|
| Rate for Payer: Cigna of CA HMO |
$716.80
|
| Rate for Payer: Cigna of CA PPO |
$828.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$952.00
|
| Rate for Payer: Global Benefits Group Commercial |
$672.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,008.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$840.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$840.00
|
| Rate for Payer: Networks By Design Commercial |
$728.00
|
| Rate for Payer: Prime Health Services Commercial |
$952.00
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$672.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
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: Blue Shield of California EPN |
$104.66
|
| Rate for Payer: Cash Price |
$88.20
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$39.20
|
| 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: United Healthcare All Other Commercial |
$74.01
|
| Rate for Payer: United Healthcare All Other HMO |
$72.28
|
| Rate for Payer: United Healthcare HMO Rider |
$70.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.68
|
|
|
HC KNEE CONTROL COND PAD
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT L2810
|
| Hospital Charge Code |
905352810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$176.40 |
| 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 |
$107.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$94.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.80
|
| Rate for Payer: Blue Distinction Transplant |
$117.60
|
| Rate for Payer: Blue Shield of California Commercial |
$147.00
|
| Rate for Payer: Blue Shield of California EPN |
$106.62
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| 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 Media |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$147.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| 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 |
$98.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98.00
|
| Rate for Payer: United Healthcare HMO Rider |
$98.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.00
|
| 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 |
$113.45 |
| Max. Negotiated Rate |
$371.70 |
| 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 |
$227.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.00
|
| Rate for Payer: Blue Distinction Transplant |
$247.80
|
| Rate for Payer: Blue Shield of California Commercial |
$309.75
|
| Rate for Payer: Blue Shield of California EPN |
$224.67
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Cash Price |
$185.85
|
| 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 Media |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$309.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$144.55
|
| 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: LLUH Dept of Risk Management WC |
$169.33
|
| 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 |
$206.50
|
| Rate for Payer: United Healthcare All Other HMO |
$206.50
|
| Rate for Payer: United Healthcare HMO Rider |
$206.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.50
|
| 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
|
$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: Blue Shield of California EPN |
$220.54
|
| Rate for Payer: Cash Price |
$185.85
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$82.60
|
| 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: United Healthcare All Other Commercial |
$155.95
|
| Rate for Payer: United Healthcare All Other HMO |
$152.31
|
| Rate for Payer: United Healthcare HMO Rider |
$149.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.29
|
|
|
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 |
$139.38 |
| Max. Negotiated Rate |
$403.20 |
| 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 |
$246.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$216.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$264.68
|
| Rate for Payer: Blue Distinction Transplant |
$268.80
|
| Rate for Payer: Blue Shield of California Commercial |
$336.00
|
| Rate for Payer: Blue Shield of California EPN |
$243.71
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| 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 Media |
$380.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$336.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$156.80
|
| 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: LLUH Dept of Risk Management WC |
$183.68
|
| 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 |
$224.00
|
| Rate for Payer: United Healthcare All Other HMO |
$224.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$224.00
|
| 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: Blue Shield of California EPN |
$239.23
|
| Rate for Payer: Cash Price |
$201.60
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$89.60
|
| 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: United Healthcare All Other Commercial |
$169.16
|
| Rate for Payer: United Healthcare All Other HMO |
$165.22
|
| Rate for Payer: United Healthcare HMO Rider |
$161.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$147.84
|
|
|
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: Blue Shield of California EPN |
$5,460.89
|
| Rate for Payer: Cash Price |
$4,601.87
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$2,045.28
|
| 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: United Healthcare All Other Commercial |
$3,861.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3,771.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3,689.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,374.71
|
|
|
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 |
$3,579.23 |
| Max. Negotiated Rate |
$9,203.74 |
| 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 |
$5,624.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,951.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,041.75
|
| Rate for Payer: Blue Distinction Transplant |
$6,135.83
|
| Rate for Payer: Blue Shield of California Commercial |
$7,669.78
|
| Rate for Payer: Blue Shield of California EPN |
$5,563.15
|
| Rate for Payer: Cash Price |
$4,601.87
|
| Rate for Payer: Cash Price |
$4,601.87
|
| 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 Media |
$8,692.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,692.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,090.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$7,669.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,579.23
|
| 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: LLUH Dept of Risk Management WC |
$4,192.82
|
| 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 |
$5,113.19
|
| Rate for Payer: United Healthcare All Other HMO |
$5,113.19
|
| Rate for Payer: United Healthcare HMO Rider |
$5,113.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,113.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,692.42
|
| Rate for Payer: Vantage Medical Group Senior |
$8,692.42
|
|
|
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 |
$20,979.00 |
| Max. Negotiated Rate |
$53,946.00 |
| 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 |
$32,967.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29,022.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35,412.55
|
| Rate for Payer: Blue Distinction Transplant |
$35,964.00
|
| Rate for Payer: Blue Shield of California Commercial |
$44,955.00
|
| Rate for Payer: Blue Shield of California EPN |
$32,607.36
|
| Rate for Payer: Cash Price |
$26,973.00
|
| 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 Media |
$50,949.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$50,949.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,976.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$44,955.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20,979.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39,979.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24,575.40
|
| 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 |
$29,970.00
|
| Rate for Payer: United Healthcare All Other HMO |
$29,970.00
|
| Rate for Payer: United Healthcare HMO Rider |
$29,970.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29,970.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50,949.00
|
| Rate for Payer: Vantage Medical Group Senior |
$50,949.00
|
|
|
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: Blue Shield of California EPN |
$32,007.96
|
| Rate for Payer: Cash Price |
$26,973.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$11,988.00
|
| 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: United Healthcare All Other Commercial |
$22,633.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22,105.87
|
| Rate for Payer: United Healthcare HMO Rider |
$21,626.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19,780.20
|
|
|
HC KNEE SLEEVE OPEN PATELLA LRG
|
Facility
|
OP
|
$37.80
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607658
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$134.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$134.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.33
|
| Rate for Payer: Blue Distinction Transplant |
$22.68
|
| Rate for Payer: Blue Shield of California Commercial |
$23.78
|
| Rate for Payer: Blue Shield of California EPN |
$18.48
|
| Rate for Payer: Cash Price |
$17.01
|
| Rate for Payer: Cash Price |
$17.01
|
| Rate for Payer: Central Health Plan Commercial |
$30.24
|
| Rate for Payer: Cigna of CA HMO |
$24.19
|
| Rate for Payer: Cigna of CA PPO |
$27.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Media |
$32.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.12
|
| Rate for Payer: Galaxy Health WC |
$32.13
|
| Rate for Payer: Global Benefits Group Commercial |
$22.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.02
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$28.35
|
| Rate for Payer: Networks By Design Commercial |
$24.57
|
| Rate for Payer: Prime Health Services Commercial |
$32.13
|
| Rate for Payer: Riverside University Health System MISP |
$15.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.90
|
| Rate for Payer: United Healthcare All Other HMO |
$18.90
|
| Rate for Payer: United Healthcare HMO Rider |
$18.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.13
|
| Rate for Payer: Vantage Medical Group Senior |
$32.13
|
|
|
HC KNEE SLEEVE OPEN PATELLA LRG
|
Facility
|
IP
|
$37.80
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607658
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$34.02 |
| Rate for Payer: Cash Price |
$17.01
|
| Rate for Payer: Central Health Plan Commercial |
$30.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.12
|
| Rate for Payer: Galaxy Health WC |
$32.13
|
| Rate for Payer: Global Benefits Group Commercial |
$22.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$28.35
|
| Rate for Payer: Networks By Design Commercial |
$24.57
|
| Rate for Payer: Prime Health Services Commercial |
$32.13
|
|
|
HC KNEE SLEEVE OPEN PATELLA XLRG
|
Facility
|
IP
|
$80.77
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607659
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$72.69 |
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Central Health Plan Commercial |
$64.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: Galaxy Health WC |
$68.65
|
| Rate for Payer: Global Benefits Group Commercial |
$48.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$60.58
|
| Rate for Payer: Networks By Design Commercial |
$52.50
|
| Rate for Payer: Prime Health Services Commercial |
$68.65
|
|
|
HC KNEE SLEEVE OPEN PATELLA XLRG
|
Facility
|
OP
|
$80.77
|
|
|
Service Code
|
CPT A4467
|
| Hospital Charge Code |
901607659
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$134.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$134.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.72
|
| Rate for Payer: Blue Distinction Transplant |
$48.46
|
| Rate for Payer: Blue Shield of California Commercial |
$50.80
|
| Rate for Payer: Blue Shield of California EPN |
$39.50
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Cash Price |
$36.35
|
| Rate for Payer: Central Health Plan Commercial |
$64.62
|
| Rate for Payer: Cigna of CA HMO |
$51.69
|
| Rate for Payer: Cigna of CA PPO |
$59.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.65
|
| Rate for Payer: Dignity Health Media |
$68.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.31
|
| Rate for Payer: Galaxy Health WC |
$68.65
|
| Rate for Payer: Global Benefits Group Commercial |
$48.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.69
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$60.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.15
|
| Rate for Payer: Multiplan Commercial |
$60.58
|
| Rate for Payer: Networks By Design Commercial |
$52.50
|
| Rate for Payer: Prime Health Services Commercial |
$68.65
|
| Rate for Payer: Riverside University Health System MISP |
$32.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.38
|
| Rate for Payer: United Healthcare All Other HMO |
$40.38
|
| Rate for Payer: United Healthcare HMO Rider |
$40.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.65
|
| Rate for Payer: Vantage Medical Group Senior |
$68.65
|
|
|
HC KNEE STANDING
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.27
|
| Rate for Payer: Blue Distinction Transplant |
$536.40
|
| Rate for Payer: Blue Shield of California Commercial |
$552.49
|
| Rate for Payer: Blue Shield of California EPN |
$434.48
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: Cigna of CA HMO |
$572.16
|
| Rate for Payer: Cigna of CA PPO |
$661.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$670.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$536.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE STANDING
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
|
|
HC KNUCKLE BENDER
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.65 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.28
|
| Rate for Payer: Blue Distinction Transplant |
$203.40
|
| Rate for Payer: Blue Shield of California Commercial |
$254.25
|
| Rate for Payer: Blue Shield of California EPN |
$184.42
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Media |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$254.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.50
|
| Rate for Payer: United Healthcare All Other HMO |
$169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$169.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC KNUCKLE BENDER
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
903203918
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Blue Shield of California EPN |
$181.03
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.01
|
| Rate for Payer: United Healthcare All Other HMO |
$125.02
|
| Rate for Payer: United Healthcare HMO Rider |
$122.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.87
|
|
|
HC KNUCKLE BENDER 2 SEGMENT/FLEX
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$158.59
|
| Rate for Payer: United Healthcare All Other HMO |
$154.90
|
| Rate for Payer: United Healthcare HMO Rider |
$151.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$138.60
|
|
|
HC KNUCKLE BENDER 2 SEGMENT/FLEX
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203922
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.48 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.14
|
| Rate for Payer: Blue Distinction Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$315.00
|
| Rate for Payer: Blue Shield of California EPN |
$228.48
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$294.00
|
| Rate for Payer: Cigna of CA PPO |
$294.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Media |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$210.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Riverside University Health System MISP |
$168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.20 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Blue Shield of California EPN |
$587.93
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.20
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$415.74
|
| Rate for Payer: United Healthcare All Other HMO |
$406.05
|
| Rate for Payer: United Healthcare HMO Rider |
$397.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$363.33
|
|
|
HC KO ADJ JTS CUSTOM FIT
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT L1832
|
| Hospital Charge Code |
905351832
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$385.35 |
| Max. Negotiated Rate |
$990.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$935.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$605.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$605.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$533.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.47
|
| Rate for Payer: Blue Distinction Transplant |
$660.60
|
| Rate for Payer: Blue Shield of California Commercial |
$825.75
|
| Rate for Payer: Blue Shield of California EPN |
$598.94
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Cash Price |
$495.45
|
| Rate for Payer: Central Health Plan Commercial |
$880.80
|
| Rate for Payer: Cigna of CA HMO |
$770.70
|
| Rate for Payer: Cigna of CA PPO |
$770.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.85
|
| Rate for Payer: Dignity Health Media |
$935.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$440.40
|
| Rate for Payer: Galaxy Health WC |
$935.85
|
| Rate for Payer: Global Benefits Group Commercial |
$660.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$825.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$385.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$734.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$729.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.41
|
| Rate for Payer: Multiplan Commercial |
$825.75
|
| Rate for Payer: Networks By Design Commercial |
$550.50
|
| Rate for Payer: Prime Health Services Commercial |
$935.85
|
| Rate for Payer: Riverside University Health System MISP |
$440.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.50
|
| Rate for Payer: United Healthcare All Other HMO |
$550.50
|
| Rate for Payer: United Healthcare HMO Rider |
$550.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.85
|
| Rate for Payer: Vantage Medical Group Senior |
$935.85
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
IP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
905351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Blue Shield of California EPN |
$482.74
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$180.80
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$341.35
|
| Rate for Payer: United Healthcare All Other HMO |
$333.40
|
| Rate for Payer: United Healthcare HMO Rider |
$326.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$298.32
|
|
|
HC KO ADJUSTABLE W AIR CHAMBERS
|
Facility
|
OP
|
$904.00
|
|
|
Service Code
|
CPT L1847
|
| Hospital Charge Code |
905351847
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$316.40 |
| Max. Negotiated Rate |
$813.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$768.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$497.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$437.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.08
|
| Rate for Payer: Blue Distinction Transplant |
$542.40
|
| Rate for Payer: Blue Shield of California Commercial |
$678.00
|
| Rate for Payer: Blue Shield of California EPN |
$491.78
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Central Health Plan Commercial |
$723.20
|
| Rate for Payer: Cigna of CA HMO |
$632.80
|
| Rate for Payer: Cigna of CA PPO |
$632.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$768.40
|
| Rate for Payer: Dignity Health Media |
$768.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$361.60
|
| Rate for Payer: Galaxy Health WC |
$768.40
|
| Rate for Payer: Global Benefits Group Commercial |
$542.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$813.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$678.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$316.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$602.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.64
|
| Rate for Payer: Multiplan Commercial |
$678.00
|
| Rate for Payer: Networks By Design Commercial |
$452.00
|
| Rate for Payer: Prime Health Services Commercial |
$768.40
|
| Rate for Payer: Riverside University Health System MISP |
$361.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$542.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$542.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.00
|
| Rate for Payer: United Healthcare All Other HMO |
$452.00
|
| Rate for Payer: United Healthcare HMO Rider |
$452.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.40
|
| Rate for Payer: Vantage Medical Group Senior |
$768.40
|
|
