|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$5,728.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,145.60 |
| Max. Negotiated Rate |
$4,868.80 |
| Rate for Payer: Adventist Health Commercial |
$1,145.60
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,291.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,291.20
|
| Rate for Payer: Galaxy Health WC |
$4,868.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,436.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,820.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,182.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,545.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.72
|
| Rate for Payer: Multiplan Commercial |
$4,582.40
|
| Rate for Payer: Networks By Design Commercial |
$3,723.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,868.80
|
|
|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
OP
|
$5,728.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$587.93 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,145.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: Cash Price |
$3,150.40
|
| Rate for Payer: Cigna of CA HMO |
$3,665.92
|
| Rate for Payer: Cigna of CA PPO |
$4,238.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$4,868.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,436.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$587.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,820.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$4,582.40
|
| Rate for Payer: Networks By Design Commercial |
$3,723.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,868.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,436.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
IP
|
$5,335.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,067.00 |
| Max. Negotiated Rate |
$4,534.75 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Cash Price |
$2,934.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,134.00
|
| Rate for Payer: Galaxy Health WC |
$4,534.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,032.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,302.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
OP
|
$5,335.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$421.56 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,934.25
|
| Rate for Payer: Cash Price |
$2,934.25
|
| Rate for Payer: Cash Price |
$2,934.25
|
| Rate for Payer: Cigna of CA HMO |
$3,414.40
|
| Rate for Payer: Cigna of CA PPO |
$3,947.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$4,534.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$421.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,558.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
IP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,687.20
|
| Rate for Payer: Cash Price |
$3,687.20
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,149.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,608.96
|
| Rate for Payer: Multiplan Commercial |
$5,363.20
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,516.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,396.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.56
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
OP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$5,698.40 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,687.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,028.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,882.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4,947.55
|
| Rate for Payer: Blue Shield of California EPN |
$3,258.14
|
| Rate for Payer: Cash Price |
$3,687.20
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,698.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,149.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,608.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,692.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,692.80
|
| Rate for Payer: Multiplan Commercial |
$5,363.20
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,022.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,022.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,516.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,396.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,698.40
|
|
|
HC ELASTOPLAST
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC ELASTOPLAST
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.37
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$303.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.75
|
| 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 |
$196.35
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Cigna of CA HMO |
$228.48
|
| Rate for Payer: Cigna of CA PPO |
$264.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$303.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$303.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$303.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$343.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$249.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$249.90
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.20
|
| 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 |
$303.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$303.45
|
| Rate for Payer: Vantage Medical Group Senior |
$303.45
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$303.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$196.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: Cigna of CA HMO |
$228.48
|
| Rate for Payer: Cigna of CA PPO |
$264.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$303.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$303.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$303.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$249.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$249.90
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$214.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other HMO |
$178.50
|
| Rate for Payer: United Healthcare HMO Rider |
$178.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$303.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$303.45
|
| Rate for Payer: Vantage Medical Group Senior |
$303.45
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$196.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$142.80
|
| Rate for Payer: Galaxy Health WC |
$303.45
|
| Rate for Payer: Global Benefits Group Commercial |
$214.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$238.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.68
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: Networks By Design Commercial |
$232.05
|
| Rate for Payer: Prime Health Services Commercial |
$303.45
|
|
|
HC ELBOW COMPLETE
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.00 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.00
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$538.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
|
|
HC ELBOW COMPLETE
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$739.50 |
| Rate for Payer: Adventist Health Commercial |
$174.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.19
|
| Rate for Payer: Blue Shield of California Commercial |
$532.44
|
| Rate for Payer: Blue Shield of California EPN |
$351.48
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cash Price |
$478.50
|
| Rate for Payer: Cigna of CA HMO |
$556.80
|
| Rate for Payer: Cigna of CA PPO |
$643.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$580.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: Networks By Design Commercial |
$565.50
|
| Rate for Payer: Prime Health Services Commercial |
$739.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$522.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$522.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.00 |
| Max. Negotiated Rate |
$522.75 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$246.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.00
|
| Rate for Payer: Galaxy Health WC |
$522.75
|
| Rate for Payer: Global Benefits Group Commercial |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$380.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Networks By Design Commercial |
$399.75
|
| Rate for Payer: Prime Health Services Commercial |
$522.75
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$522.75 |
| Rate for Payer: Adventist Health Commercial |
$123.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$403.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.49
|
| Rate for Payer: Blue Shield of California Commercial |
$376.38
|
| Rate for Payer: Blue Shield of California EPN |
$248.46
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cash Price |
$338.25
|
| Rate for Payer: Cigna of CA HMO |
$393.60
|
| Rate for Payer: Cigna of CA PPO |
$455.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$522.75
|
| Rate for Payer: Global Benefits Group Commercial |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$410.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Networks By Design Commercial |
$399.75
|
| Rate for Payer: Prime Health Services Commercial |
$522.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$369.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$369.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
915356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$336.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.92
|
| Rate for Payer: Multiplan Commercial |
$1,346.40
|
| Rate for Payer: Networks By Design Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
915356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$403.92 |
| Max. Negotiated Rate |
$1,430.55 |
| Rate for Payer: Adventist Health Commercial |
$690.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,262.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$974.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.05
|
| Rate for Payer: Blue Shield of California EPN |
$817.94
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,430.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,430.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,178.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,178.10
|
| Rate for Payer: Multiplan Commercial |
$1,346.40
|
| Rate for Payer: Networks By Design Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,430.55
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
905356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$403.92 |
| Max. Negotiated Rate |
$1,430.55 |
| Rate for Payer: Adventist Health Commercial |
$690.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,262.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$974.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,242.05
|
| Rate for Payer: Blue Shield of California EPN |
$817.94
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,430.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,430.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,178.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,178.10
|
| Rate for Payer: Multiplan Commercial |
$1,346.40
|
| Rate for Payer: Networks By Design Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,430.55
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
905356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$336.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$403.92
|
| Rate for Payer: Multiplan Commercial |
$1,346.40
|
| Rate for Payer: Networks By Design Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
|
|
HC ELBOW SOCKET INS USE W/O LCK
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L6695
|
| Hospital Charge Code |
915356695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.28
|
| Rate for Payer: Multiplan Commercial |
$897.60
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
|
|
HC ELBOW SOCKET INS USE W/O LCK
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT L6695
|
| Hospital Charge Code |
915356695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.28 |
| Max. Negotiated Rate |
$953.70 |
| Rate for Payer: Adventist Health Commercial |
$460.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$649.86
|
| Rate for Payer: Blue Shield of California Commercial |
$828.04
|
| Rate for Payer: Blue Shield of California EPN |
$545.29
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$953.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$953.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$703.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$785.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$785.40
|
| Rate for Payer: Multiplan Commercial |
$897.60
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$953.70
|
| Rate for Payer: Vantage Medical Group Senior |
$953.70
|
|
|
HC ELBOW SOCKET INS USE W/O LCK
|
Facility
|
OP
|
$1,122.00
|
|
|
Service Code
|
CPT L6695
|
| Hospital Charge Code |
905356695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.28 |
| Max. Negotiated Rate |
$953.70 |
| Rate for Payer: Adventist Health Commercial |
$460.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$617.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$841.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$649.86
|
| Rate for Payer: Blue Shield of California Commercial |
$828.04
|
| Rate for Payer: Blue Shield of California EPN |
$545.29
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$953.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$953.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$953.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$703.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$785.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$785.40
|
| Rate for Payer: Multiplan Commercial |
$897.60
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$953.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$953.70
|
| Rate for Payer: Vantage Medical Group Senior |
$953.70
|
|
|
HC ELBOW SOCKET INS USE W/O LCK
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L6695
|
| Hospital Charge Code |
905356695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.28
|
| Rate for Payer: Multiplan Commercial |
$897.60
|
| Rate for Payer: Networks By Design Commercial |
$561.00
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
|
|
HC ELEC HAND IND ART DIGITS
|
Facility
|
IP
|
$66,573.55
|
|
|
Service Code
|
CPT L6880
|
| Hospital Charge Code |
905356880
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13,314.71 |
| Max. Negotiated Rate |
$56,587.52 |
| Rate for Payer: Adventist Health Commercial |
$13,314.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$36,615.45
|
| Rate for Payer: Cash Price |
$36,615.45
|
| Rate for Payer: Cigna of CA HMO |
$46,601.49
|
| Rate for Payer: Cigna of CA PPO |
$46,601.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,629.42
|
| Rate for Payer: EPIC Health Plan Senior |
$26,629.42
|
| Rate for Payer: Galaxy Health WC |
$56,587.52
|
| Rate for Payer: Global Benefits Group Commercial |
$39,944.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44,404.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,364.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41,209.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,977.65
|
| Rate for Payer: Multiplan Commercial |
$53,258.84
|
| Rate for Payer: Networks By Design Commercial |
$33,286.78
|
| Rate for Payer: Prime Health Services Commercial |
$56,587.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,985.05
|
| Rate for Payer: United Healthcare All Other HMO |
$24,319.32
|
| Rate for Payer: United Healthcare HMO Rider |
$23,793.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21,802.84
|
|
