|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$581.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$898.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$898.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$898.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$739.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$739.90
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.50
|
| Rate for Payer: United Healthcare All Other HMO |
$528.50
|
| Rate for Payer: United Healthcare HMO Rider |
$528.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$898.45
|
| Rate for Payer: Vantage Medical Group Senior |
$898.45
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,027.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$564.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$770.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: Cigna of CA HMO |
$657.28
|
| Rate for Payer: Cigna of CA PPO |
$759.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$872.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$872.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$872.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$635.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$718.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$718.90
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$616.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$872.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$872.95
|
| Rate for Payer: Vantage Medical Group Senior |
$872.95
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,027.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$205.40 |
| Max. Negotiated Rate |
$872.95 |
| Rate for Payer: Adventist Health Commercial |
$205.40
|
| Rate for Payer: Cash Price |
$462.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$410.80
|
| Rate for Payer: Galaxy Health WC |
$872.95
|
| Rate for Payer: Global Benefits Group Commercial |
$616.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$685.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$391.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$635.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$821.60
|
| Rate for Payer: Networks By Design Commercial |
$667.55
|
| Rate for Payer: Prime Health Services Commercial |
$872.95
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$581.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$898.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$898.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$898.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$739.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$739.90
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$898.45
|
| Rate for Payer: Vantage Medical Group Senior |
$898.45
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$13,622.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$217.31 |
| Max. Negotiated Rate |
$11,578.70 |
| Rate for Payer: Adventist Health Commercial |
$2,724.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,934.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.85
|
| Rate for Payer: Blue Shield of California Commercial |
$8,336.66
|
| Rate for Payer: Blue Shield of California EPN |
$5,503.29
|
| Rate for Payer: Cash Price |
$6,129.90
|
| Rate for Payer: Cash Price |
$6,129.90
|
| Rate for Payer: Cigna of CA HMO |
$8,718.08
|
| Rate for Payer: Cigna of CA PPO |
$10,080.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$11,578.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,173.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,085.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,269.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$10,897.60
|
| Rate for Payer: Networks By Design Commercial |
$8,854.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,578.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,173.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,173.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$10,068.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$217.31 |
| Max. Negotiated Rate |
$11,264.31 |
| Rate for Payer: Adventist Health Commercial |
$2,013.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,603.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.85
|
| Rate for Payer: Blue Shield of California Commercial |
$6,161.62
|
| Rate for Payer: Blue Shield of California EPN |
$4,067.47
|
| Rate for Payer: Cash Price |
$4,530.60
|
| Rate for Payer: Cash Price |
$4,530.60
|
| Rate for Payer: Cigna of CA HMO |
$6,443.52
|
| Rate for Payer: Cigna of CA PPO |
$7,450.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$8,557.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,040.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$217.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,715.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,416.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$8,054.40
|
| Rate for Payer: Networks By Design Commercial |
$6,544.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,557.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,040.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,040.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$10,068.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,013.60 |
| Max. Negotiated Rate |
$8,557.80 |
| Rate for Payer: Adventist Health Commercial |
$2,013.60
|
| Rate for Payer: Cash Price |
$4,530.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,027.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,027.20
|
| Rate for Payer: Galaxy Health WC |
$8,557.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,040.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,715.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,835.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,232.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,416.32
|
| Rate for Payer: Multiplan Commercial |
$8,054.40
|
| Rate for Payer: Networks By Design Commercial |
$6,544.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,557.80
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$13,622.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,724.40 |
| Max. Negotiated Rate |
$11,578.70 |
| Rate for Payer: Adventist Health Commercial |
$2,724.40
|
| Rate for Payer: Cash Price |
$6,129.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,448.80
|
| Rate for Payer: Galaxy Health WC |
$11,578.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,173.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,085.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,189.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,432.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,269.28
|
| Rate for Payer: Multiplan Commercial |
$10,897.60
|
| Rate for Payer: Networks By Design Commercial |
$8,854.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,578.70
|
|
|
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 |
$274.00 |
| Max. Negotiated Rate |
$1,164.50 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$848.03
|
| 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 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 |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 HMO |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$1,013.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,164.50
|
| Rate for Payer: Global Benefits Group Commercial |
$822.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| 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 |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,096.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$890.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,164.50
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| 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: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: Cigna of CA HMO |
$837.12
|
| Rate for Payer: Cigna of CA PPO |
$967.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,111.80
|
| Rate for Payer: Global Benefits Group Commercial |
$784.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$872.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,046.40
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$850.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,111.80
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$784.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.00
|
| Rate for Payer: United Healthcare All Other HMO |
$654.00
|
| Rate for Payer: United Healthcare HMO Rider |
$654.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$261.60 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Cash Price |
$588.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.20
|
| Rate for Payer: EPIC Health Plan Senior |
$523.20
|
| Rate for Payer: Galaxy Health WC |
$1,111.80
|
| Rate for Payer: Global Benefits Group Commercial |
$784.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$872.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$809.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.92
|
| Rate for Payer: Multiplan Commercial |
$1,046.40
|
| Rate for Payer: Networks By Design Commercial |
$850.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,111.80
|
|
|
HC ARTHRITIS SERIES
|
Facility
|
IP
|
$2,127.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$425.40 |
| Max. Negotiated Rate |
$1,807.95 |
| Rate for Payer: Adventist Health Commercial |
$425.40
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.80
|
| Rate for Payer: EPIC Health Plan Senior |
$850.80
|
| Rate for Payer: Galaxy Health WC |
$1,807.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,276.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,316.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.48
|
| Rate for Payer: Multiplan Commercial |
$1,701.60
|
| Rate for Payer: Networks By Design Commercial |
$1,382.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.95
|
|
|
HC ARTHRITIS SERIES
|
Facility
|
OP
|
$2,127.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.88 |
| Max. Negotiated Rate |
$1,807.95 |
| Rate for Payer: Adventist Health Commercial |
$425.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,395.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,301.72
|
| Rate for Payer: Blue Shield of California EPN |
$859.31
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: Cash Price |
$957.15
|
| Rate for Payer: Cigna of CA HMO |
$1,361.28
|
| Rate for Payer: Cigna of CA PPO |
$1,573.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,807.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,276.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,701.60
|
| Rate for Payer: Networks By Design Commercial |
$1,382.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,276.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,276.20
|
| 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: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$1,028.50 |
| Rate for Payer: Adventist Health Commercial |
$242.00
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$484.00
|
| Rate for Payer: EPIC Health Plan Senior |
$484.00
|
| Rate for Payer: Galaxy Health WC |
$1,028.50
|
| Rate for Payer: Global Benefits Group Commercial |
$726.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$807.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$748.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.40
|
| Rate for Payer: Multiplan Commercial |
$968.00
|
| Rate for Payer: Networks By Design Commercial |
$786.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,028.50
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$1,028.50 |
| Rate for Payer: Adventist Health Commercial |
$242.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$793.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.96
|
| Rate for Payer: Blue Shield of California Commercial |
$740.52
|
| Rate for Payer: Blue Shield of California EPN |
$488.84
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cash Price |
$544.50
|
| Rate for Payer: Cigna of CA HMO |
$774.40
|
| Rate for Payer: Cigna of CA PPO |
$895.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$1,028.50
|
| Rate for Payer: Global Benefits Group Commercial |
$726.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$807.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$968.00
|
| Rate for Payer: Networks By Design Commercial |
$786.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,028.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$726.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$726.00
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
IP
|
$1,368.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: EPIC Health Plan Commercial |
$547.20
|
| Rate for Payer: Adventist Health Commercial |
$273.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: EPIC Health Plan Senior |
$547.20
|
| Rate for Payer: Galaxy Health WC |
$1,162.80
|
| Rate for Payer: Global Benefits Group Commercial |
$820.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$912.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$521.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$846.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.32
|
| Rate for Payer: Multiplan Commercial |
$1,094.40
|
| Rate for Payer: Networks By Design Commercial |
$889.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,162.80
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
OP
|
$1,368.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$120.66 |
| Max. Negotiated Rate |
$1,162.80 |
| Rate for Payer: Adventist Health Commercial |
$273.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$897.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.96
|
| Rate for Payer: Blue Shield of California Commercial |
$837.22
|
| Rate for Payer: Blue Shield of California EPN |
$552.67
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna of CA HMO |
$875.52
|
| Rate for Payer: Cigna of CA PPO |
$1,012.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$1,162.80
|
| Rate for Payer: Global Benefits Group Commercial |
$820.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$912.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$1,094.40
|
| Rate for Payer: Networks By Design Commercial |
$889.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,162.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$820.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$820.80
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$126.49 |
| Max. Negotiated Rate |
$1,699.15 |
| Rate for Payer: Adventist Health Commercial |
$399.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,311.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,223.39
|
| Rate for Payer: Blue Shield of California EPN |
$807.60
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cigna of CA HMO |
$1,279.36
|
| Rate for Payer: Cigna of CA PPO |
$1,479.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,199.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,199.40
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$1,699.15 |
| Rate for Payer: Adventist Health Commercial |
$399.80
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.60
|
| Rate for Payer: EPIC Health Plan Senior |
$799.60
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,237.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.76
|
| Rate for Payer: Multiplan Commercial |
$1,599.20
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
IP
|
$1,540.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$1,309.00 |
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$616.00
|
| Rate for Payer: Galaxy Health WC |
$1,309.00
|
| Rate for Payer: Global Benefits Group Commercial |
$924.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,027.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$953.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.60
|
| Rate for Payer: Multiplan Commercial |
$1,232.00
|
| Rate for Payer: Networks By Design Commercial |
$1,001.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,309.00
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
OP
|
$1,540.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$116.29 |
| Max. Negotiated Rate |
$1,309.00 |
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,010.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.51
|
| Rate for Payer: Blue Shield of California Commercial |
$942.48
|
| Rate for Payer: Blue Shield of California EPN |
$622.16
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cash Price |
$693.00
|
| Rate for Payer: Cigna of CA HMO |
$985.60
|
| Rate for Payer: Cigna of CA PPO |
$1,139.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$1,309.00
|
| Rate for Payer: Global Benefits Group Commercial |
$924.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,027.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$1,232.00
|
| Rate for Payer: Networks By Design Commercial |
$1,001.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,309.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$924.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$924.00
|
| 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: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
|
IP
|
$2,468.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$493.60 |
| Max. Negotiated Rate |
$2,097.80 |
| Rate for Payer: Adventist Health Commercial |
$493.60
|
| Rate for Payer: Cash Price |
$1,110.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$987.20
|
| Rate for Payer: EPIC Health Plan Senior |
$987.20
|
| Rate for Payer: Galaxy Health WC |
$2,097.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,480.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,646.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$940.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,527.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.32
|
| Rate for Payer: Multiplan Commercial |
$1,974.40
|
| Rate for Payer: Networks By Design Commercial |
$1,604.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,097.80
|
|
