|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$959.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$869.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.30
|
| 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
|
230
|
| Min. Negotiated Rate |
$63.79 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$274.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$959.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$869.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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: TriValley Medical Group Commercial/Senior |
$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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
230
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$959.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$869.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.30
|
| 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
|
IP
|
$1,370.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$959.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$869.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$808.30
|
| 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
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$915.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$830.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$536.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$248.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$915.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$830.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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: TriValley Medical Group Commercial/Senior |
$784.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$915.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$830.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$771.72
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$915.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$830.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$771.72
|
| 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 ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
IP
|
$1,308.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$915.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$830.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$771.72
|
| 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 ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$1,308.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$54.42 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$261.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$915.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$830.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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 |
$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: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,350.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.93
|
| 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 |
$545.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,357.03
|
| Rate for Payer: Blue Shield of California Commercial |
$895.47
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| 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/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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 |
$550.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.55
|
| Rate for Payer: Blue Shield of California Commercial |
$509.41
|
| Rate for Payer: Blue Shield of California Commercial |
$771.98
|
| 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 |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$847.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| 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/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$768.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$290.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| 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 |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$847.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$768.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$713.90
|
| 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 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 |
$508.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.55
|
| Rate for Payer: Blue Shield of California Commercial |
$575.93
|
| Rate for Payer: Blue Shield of California Commercial |
$872.78
|
| 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 |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| 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/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$120.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$868.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| 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 |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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: Adventist Health Commercial |
$273.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$957.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$547.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$868.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$807.12
|
| 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 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 |
$523.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,275.36
|
| Rate for Payer: Blue Shield of California Commercial |
$841.58
|
| 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 |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,399.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| 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/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$126.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,269.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$143.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$479.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| 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 |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,399.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,269.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,179.41
|
| 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
|
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 |
$743.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.83
|
| Rate for Payer: Blue Shield of California Commercial |
$648.34
|
| Rate for Payer: Blue Shield of California Commercial |
$982.52
|
| 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 |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,078.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| 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/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$116.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$977.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| 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 |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,078.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$977.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$908.60
|
| 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 SHOULDER
|
Facility
|
OP
|
$2,468.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$85.16 |
| Max. Negotiated Rate |
$2,097.80 |
| Rate for Payer: Adventist Health Commercial |
$493.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$581.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,039.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,574.58
|
| Rate for Payer: Cash Price |
$1,110.60
|
| Rate for Payer: Cash Price |
$1,110.60
|
| Rate for Payer: Cigna of CA HMO |
$1,579.52
|
| Rate for Payer: Cigna of CA PPO |
$1,826.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,727.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$2,097.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,480.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,567.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,480.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,480.80
|
| 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 |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,727.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,567.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,456.12
|
| 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
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$69.12 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$586.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,068.65
|
| Rate for Payer: Blue Shield of California Commercial |
$705.17
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Cigna of CA HMO |
$1,072.00
|
| Rate for Payer: Cigna of CA PPO |
$1,239.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.00
|
| 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 |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Cash Price |
$753.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,063.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$988.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$1,088.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
|
OP
|
$11,858.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.31 |
| Max. Negotiated Rate |
$10,079.30 |
| Rate for Payer: Adventist Health Commercial |
$2,371.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$5,336.10
|
| Rate for Payer: Cash Price |
$5,336.10
|
| Rate for Payer: Cash Price |
$5,336.10
|
| Rate for Payer: Cigna of CA HMO |
$7,589.12
|
| Rate for Payer: Cigna of CA PPO |
$8,774.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,300.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$10,079.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,114.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,529.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,845.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$9,486.40
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$7,707.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,079.30
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,114.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,929.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,929.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,929.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,929.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
