|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,145.60
|
| Rate for Payer: Adventist Health Commercial |
$619.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$2,577.60
|
| Rate for Payer: Cigna of CA HMO |
$3,665.92
|
| Rate for Payer: Cigna of CA HMO |
$1,981.44
|
| Rate for Payer: Cigna of CA PPO |
$2,291.04
|
| Rate for Payer: Cigna of CA PPO |
$4,238.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,009.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,167.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: Galaxy Health WC |
$4,868.80
|
| Rate for Payer: Galaxy Health WC |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,436.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$587.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$587.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,637.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,965.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,374.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,838.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,838.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$2,476.80
|
| Rate for Payer: Multiplan Commercial |
$4,582.40
|
| Rate for Payer: Networks By Design Commercial |
$3,723.20
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,868.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,631.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,436.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,857.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,548.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,864.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| 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 HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,067.00
|
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$2,400.75
|
| Rate for Payer: Cigna of CA HMO |
$3,414.40
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| Rate for Payer: Cigna of CA PPO |
$3,947.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,734.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,496.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$4,534.75
|
| Rate for Payer: Galaxy Health WC |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,201.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$421.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$421.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,387.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,264.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$855.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,280.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,852.80
|
| Rate for Payer: Multiplan Commercial |
$4,268.00
|
| Rate for Payer: Networks By Design Commercial |
$3,467.75
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,534.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,201.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,139.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,783.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,667.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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 |
$2,400.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,734.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,387.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,147.65
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cash Price |
$3,016.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,257.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,955.36
|
| 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 |
$4,057.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,398.93
|
| Rate for Payer: Blue Shield of California Commercial |
$5,155.38
|
| Rate for Payer: Cash Price |
$3,016.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$4,257.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,433.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,955.36
|
| 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
|
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 |
$7.70
|
| Rate for Payer: Cash Price |
$5.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| 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 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 |
$5.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.08
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$388.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.63
|
| 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 |
$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
|
361
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$303.45 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.63
|
| 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
|
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 |
$160.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.63
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$71.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| Rate for Payer: Cash Price |
$160.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$249.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$226.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$388.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$210.63
|
| 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 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 |
$185.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.44
|
| Rate for Payer: Blue Shield of California Commercial |
$366.27
|
| Rate for Payer: Blue Shield of California Commercial |
$555.06
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$609.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$739.50
|
| Rate for Payer: Global Benefits Group Commercial |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$552.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$391.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$609.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$552.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$513.30
|
| 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 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 |
$148.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.13
|
| Rate for Payer: Blue Shield of California Commercial |
$258.92
|
| Rate for Payer: Blue Shield of California Commercial |
$392.37
|
| Rate for Payer: Cash Price |
$276.75
|
| Rate for Payer: Cash Price |
$276.75
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$430.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$522.75
|
| Rate for Payer: Global Benefits Group Commercial |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$390.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$276.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$430.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$390.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$362.85
|
| 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 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 |
$1,018.72
|
| Rate for Payer: Blue Shield of California Commercial |
$853.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,294.23
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cash Price |
$757.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.97
|
| 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 |
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 |
$1,018.72
|
| Rate for Payer: Blue Shield of California Commercial |
$853.28
|
| Rate for Payer: Blue Shield of California Commercial |
$1,294.23
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cash Price |
$757.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$844.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,068.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.97
|
| 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 |
915356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$336.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,068.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.97
|
| 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 |
$1,093.95
|
| 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
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
905356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$336.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cash Price |
$757.35
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,068.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$992.97
|
| 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 |
$1,093.95
|
| 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
|
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 |
$679.15
|
| Rate for Payer: Blue Shield of California Commercial |
$862.82
|
| Rate for Payer: Blue Shield of California Commercial |
$568.85
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$703.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| 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 |
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 |
$679.15
|
| Rate for Payer: Blue Shield of California Commercial |
$862.82
|
| Rate for Payer: Blue Shield of California Commercial |
$568.85
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$703.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$795.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| 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 |
$729.30
|
| 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
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L6695
|
| Hospital Charge Code |
915356695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$712.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.98
|
| 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 |
$729.30
|
| 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 ELCTRNIC CHROMOENDSCPY NBI
|
Facility
|
OP
|
$2,990.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745400
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$598.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$598.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,196.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,918.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Cigna of CA HMO |
$1,913.60
|
| Rate for Payer: Cigna of CA PPO |
$2,212.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,315.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,196.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,093.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,973.53
|
| Rate for Payer: EPIC Health Plan Senior |
$1,315.69
|
| Rate for Payer: Galaxy Health WC |
$2,541.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,794.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,961.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,196.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,507.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,602.75
|
| Rate for Payer: Multiplan Commercial |
$2,392.00
|
| Rate for Payer: Networks By Design Commercial |
$1,943.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,541.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,794.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,435.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,495.00
|
| 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 |
$1,196.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,794.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,315.69
|
| Rate for Payer: Vantage Medical Group Senior |
$1,196.08
|
|
|
HC ELCTRNIC CHROMOENDSCPY NBI
|
Facility
|
IP
|
$2,990.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745400
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$598.00 |
| Max. Negotiated Rate |
$2,541.50 |
| Rate for Payer: Adventist Health Commercial |
$598.00
|
| Rate for Payer: Cash Price |
$1,345.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,093.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,196.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,196.00
|
| Rate for Payer: Galaxy Health WC |
$2,541.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,794.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,898.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,764.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$2,392.00
|
| Rate for Payer: Networks By Design Commercial |
$1,943.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,541.50
|
|
