|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
OP
|
$1,370.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$822.00
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,027.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$822.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$685.00
|
| Rate for Payer: United Healthcare All Other HMO |
$685.00
|
| Rate for Payer: United Healthcare HMO Rider |
$685.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$685.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$1,164.50 |
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$913.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.36 |
| Max. Negotiated Rate |
$1,138.15 |
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.36
|
| Rate for Payer: Multiplan Commercial |
$1,071.20
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$803.40
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Cigna of CA PPO |
$990.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,004.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,071.20
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$803.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.50
|
| Rate for Payer: United Healthcare All Other HMO |
$669.50
|
| Rate for Payer: United Healthcare HMO Rider |
$669.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ARTHRITIS SERIES
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$481.58
|
| 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 HMO/PPO |
$376.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,501.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,478.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,173.44
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: Cigna of CA HMO |
$1,601.28
|
| Rate for Payer: Cigna of CA PPO |
$1,851.48
|
| 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 |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,876.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,501.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,501.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| 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 ARTHRITIS SERIES
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$600.48 |
| Max. Negotiated Rate |
$2,126.70 |
| Rate for Payer: Cash Price |
$1,125.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,000.80
|
| Rate for Payer: Galaxy Health WC |
$2,126.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,501.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,668.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$953.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.48
|
| Rate for Payer: Multiplan Commercial |
$2,001.60
|
| Rate for Payer: Networks By Design Commercial |
$1,626.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,126.70
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$143.05 |
| Max. Negotiated Rate |
$1,210.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$485.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.88
|
| Rate for Payer: Blue Distinction Transplant |
$854.40
|
| Rate for Payer: Blue Shield of California Commercial |
$841.58
|
| Rate for Payer: Blue Shield of California EPN |
$667.86
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna of CA HMO |
$911.36
|
| Rate for Payer: Cigna of CA PPO |
$1,053.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$1,210.40
|
| Rate for Payer: Global Benefits Group Commercial |
$854.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,068.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$949.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: Networks By Design Commercial |
$925.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,210.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$854.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$854.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
IP
|
$1,424.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$341.76 |
| Max. Negotiated Rate |
$1,210.40 |
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$569.60
|
| Rate for Payer: Galaxy Health WC |
$1,210.40
|
| Rate for Payer: Global Benefits Group Commercial |
$854.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$949.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.76
|
| Rate for Payer: Multiplan Commercial |
$1,139.20
|
| Rate for Payer: Networks By Design Commercial |
$925.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,210.40
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
OP
|
$1,609.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$136.46 |
| Max. Negotiated Rate |
$1,367.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$449.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.88
|
| Rate for Payer: Blue Distinction Transplant |
$965.40
|
| Rate for Payer: Blue Shield of California Commercial |
$950.92
|
| Rate for Payer: Blue Shield of California EPN |
$754.62
|
| Rate for Payer: Cash Price |
$724.05
|
| Rate for Payer: Cash Price |
$724.05
|
| Rate for Payer: Cigna of CA HMO |
$1,029.76
|
| Rate for Payer: Cigna of CA PPO |
$1,190.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$1,367.65
|
| Rate for Payer: Global Benefits Group Commercial |
$965.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$1,287.20
|
| Rate for Payer: Networks By Design Commercial |
$1,045.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,367.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$965.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$965.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
IP
|
$1,609.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$386.16 |
| Max. Negotiated Rate |
$1,367.65 |
| Rate for Payer: Cash Price |
$724.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.60
|
| Rate for Payer: Galaxy Health WC |
$1,367.65
|
| Rate for Payer: Global Benefits Group Commercial |
$965.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,073.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$613.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.16
|
| Rate for Payer: Multiplan Commercial |
$1,287.20
|
| Rate for Payer: Networks By Design Commercial |
$1,045.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,367.65
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
OP
|
$2,352.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$143.05 |
| Max. Negotiated Rate |
$1,999.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$462.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,411.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,390.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,103.09
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cigna of CA HMO |
$1,505.28
|
| Rate for Payer: Cigna of CA PPO |
$1,740.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$1,999.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,411.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,764.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,568.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$1,881.60
|
| Rate for Payer: Networks By Design Commercial |
$1,528.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,999.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,411.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,411.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
IP
|
$2,352.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,999.20 |
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.80
|
| Rate for Payer: Galaxy Health WC |
$1,999.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,411.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,568.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$896.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.48
|
| Rate for Payer: Multiplan Commercial |
$1,881.60
|
| Rate for Payer: Networks By Design Commercial |
$1,528.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,999.20
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
OP
|
$1,812.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$131.52 |
| Max. Negotiated Rate |
$1,540.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$656.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.02
|
| Rate for Payer: Blue Distinction Transplant |
$1,087.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,070.89
|
| Rate for Payer: Blue Shield of California EPN |
$849.83
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: Cigna of CA HMO |
$1,159.68
|
| Rate for Payer: Cigna of CA PPO |
$1,340.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,359.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,087.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,087.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
IP
|
$1,812.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$434.88 |
| Max. Negotiated Rate |
$1,540.20 |
| Rate for Payer: Cash Price |
$815.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$724.80
|
| Rate for Payer: Galaxy Health WC |
$1,540.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,087.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,208.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$690.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.88
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: Networks By Design Commercial |
$1,177.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,540.20
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
|
IP
|
$2,903.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$696.72 |
| Max. Negotiated Rate |
$2,467.55 |
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.20
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,106.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.72
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
|
OP
|
$2,903.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$2,467.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$514.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.88
|
| Rate for Payer: Blue Distinction Transplant |
$1,741.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,361.51
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cigna of CA HMO |
$1,857.92
|
| Rate for Payer: Cigna of CA PPO |
$2,148.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,177.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,741.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,741.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
IP
|
$1,971.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$473.04 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$788.40
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
OP
|
$1,971.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$1,675.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$518.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$409.94
|
| Rate for Payer: Blue Distinction Transplant |
$1,182.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,164.86
|
| Rate for Payer: Blue Shield of California EPN |
$924.40
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cash Price |
$886.95
|
| Rate for Payer: Cigna of CA HMO |
$1,261.44
|
| Rate for Payer: Cigna of CA PPO |
$1,458.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$1,675.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,182.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,478.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,314.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$1,576.80
|
| Rate for Payer: Networks By Design Commercial |
$1,281.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,675.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,182.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,182.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
|
IP
|
$12,132.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,911.68 |
| Max. Negotiated Rate |
$10,312.20 |
| Rate for Payer: Blue Shield of California Commercial |
$8,637.98
|
| Rate for Payer: Blue Shield of California EPN |
$6,211.58
|
| Rate for Payer: Cash Price |
$5,459.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,852.80
|
| Rate for Payer: Galaxy Health WC |
$10,312.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,279.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,092.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,622.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,911.68
|
| Rate for Payer: Multiplan Commercial |
$9,705.60
|
| Rate for Payer: Networks By Design Commercial |
$7,885.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,312.20
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
|
OP
|
$12,132.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$10,312.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,279.20
|
| Rate for Payer: Cash Price |
$5,459.40
|
| Rate for Payer: Cash Price |
$5,459.40
|
| Rate for Payer: Cash Price |
$5,459.40
|
| Rate for Payer: Cigna of CA PPO |
$8,977.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$10,312.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7,279.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,099.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,092.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,911.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$9,705.60
|
| Rate for Payer: Networks By Design Commercial |
$7,885.80
|
| Rate for Payer: Prime Health Services Commercial |
$10,312.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,279.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,066.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,066.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,066.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
IP
|
$2,029.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.96 |
| Max. Negotiated Rate |
$1,724.65 |
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$811.60
|
| Rate for Payer: Galaxy Health WC |
$1,724.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,217.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.96
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: Networks By Design Commercial |
$1,318.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,724.65
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
OP
|
$2,029.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,217.40
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cigna of CA PPO |
$1,501.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,724.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,217.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,521.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: Networks By Design Commercial |
$1,318.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,724.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,217.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,014.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,014.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,014.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.65 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$675.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA PPO |
$833.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$844.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,417.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,399.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
IP
|
$1,126.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$270.24 |
| Max. Negotiated Rate |
$957.10 |
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.40
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
OP
|
$1,126.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$675.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cash Price |
$506.70
|
| Rate for Payer: Cigna of CA PPO |
$833.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$957.10
|
| Rate for Payer: Global Benefits Group Commercial |
$675.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$844.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$900.80
|
| Rate for Payer: Networks By Design Commercial |
$731.90
|
| Rate for Payer: Prime Health Services Commercial |
$957.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$675.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
