|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$80,419.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906811496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,140.22 |
| Max. Negotiated Rate |
$68,356.15 |
| Rate for Payer: Adventist Health Commercial |
$16,083.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44,230.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60,314.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$44,230.45
|
| Rate for Payer: Cash Price |
$44,230.45
|
| Rate for Payer: Cash Price |
$44,230.45
|
| Rate for Payer: Cigna of CA HMO |
$51,468.16
|
| Rate for Payer: Cigna of CA PPO |
$59,510.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$68,356.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68,356.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$32,167.60
|
| Rate for Payer: EPIC Health Plan Senior |
$32,167.60
|
| Rate for Payer: Galaxy Health WC |
$68,356.15
|
| Rate for Payer: Global Benefits Group Commercial |
$48,251.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,140.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53,639.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49,779.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,300.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56,293.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56,293.30
|
| Rate for Payer: Multiplan Commercial |
$64,335.20
|
| Rate for Payer: Networks By Design Commercial |
$52,272.35
|
| Rate for Payer: Prime Health Services Commercial |
$68,356.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48,251.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68,356.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68,356.15
|
| Rate for Payer: Vantage Medical Group Senior |
$68,356.15
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
IP
|
$78,157.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906820337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,631.40 |
| Max. Negotiated Rate |
$66,433.45 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$31,262.80
|
| Rate for Payer: Galaxy Health WC |
$66,433.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46,894.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,130.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29,777.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,379.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,757.68
|
| Rate for Payer: Multiplan Commercial |
$62,525.60
|
| Rate for Payer: Networks By Design Commercial |
$50,802.05
|
| Rate for Payer: Prime Health Services Commercial |
$66,433.45
|
|
|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906820337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,140.22 |
| Max. Negotiated Rate |
$66,433.45 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,986.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58,617.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cigna of CA HMO |
$50,020.48
|
| Rate for Payer: Cigna of CA PPO |
$57,836.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$66,433.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66,433.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$31,262.80
|
| Rate for Payer: Galaxy Health WC |
$66,433.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46,894.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,140.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,130.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,379.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,757.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,709.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,709.90
|
| Rate for Payer: Multiplan Commercial |
$62,525.60
|
| Rate for Payer: Networks By Design Commercial |
$50,802.05
|
| Rate for Payer: Prime Health Services Commercial |
$66,433.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Senior |
$66,433.45
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$11,866.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,373.20 |
| Max. Negotiated Rate |
$10,086.10 |
| Rate for Payer: Adventist Health Commercial |
$2,373.20
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,746.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,746.40
|
| Rate for Payer: Galaxy Health WC |
$10,086.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,119.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,914.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,520.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,345.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.84
|
| Rate for Payer: Multiplan Commercial |
$9,492.80
|
| Rate for Payer: Networks By Design Commercial |
$7,712.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,086.10
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$11,866.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$277.44 |
| Max. Negotiated Rate |
$15,561.00 |
| Rate for Payer: Adventist Health Commercial |
$2,373.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,086.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,526.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,899.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| 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 |
$6,526.30
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Cigna of CA HMO |
$7,712.90
|
| Rate for Payer: Cigna of CA PPO |
$8,780.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,086.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,086.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,086.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,746.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,746.40
|
| Rate for Payer: Galaxy Health WC |
$10,086.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,119.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,914.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,345.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,306.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,306.20
|
| Rate for Payer: Multiplan Commercial |
$9,492.80
|
| Rate for Payer: Networks By Design Commercial |
$7,712.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,086.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,119.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,119.60
|
| 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 |
$10,086.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,086.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,086.10
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$12,209.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,441.80 |
| Max. Negotiated Rate |
$10,377.65 |
| Rate for Payer: Adventist Health Commercial |
$2,441.80
|
| Rate for Payer: Cash Price |
$6,714.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,883.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,883.60
|
| Rate for Payer: Galaxy Health WC |
$10,377.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,325.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,143.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,651.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,557.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,930.16
|
| Rate for Payer: Multiplan Commercial |
$9,767.20
|
| Rate for Payer: Networks By Design Commercial |
$7,935.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,377.65
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$12,209.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$277.44 |
| Max. Negotiated Rate |
$15,561.00 |
| Rate for Payer: Adventist Health Commercial |
$2,441.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,377.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,714.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,156.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| 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 |
$6,714.95
|
| Rate for Payer: Cash Price |
$6,714.95
|
| Rate for Payer: Cash Price |
$6,714.95
|
| Rate for Payer: Cigna of CA HMO |
$7,935.85
|
| Rate for Payer: Cigna of CA PPO |
$9,034.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,377.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,377.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,377.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,883.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,883.60
|
| Rate for Payer: Galaxy Health WC |
$10,377.65
|
| Rate for Payer: Global Benefits Group Commercial |
$7,325.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,143.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,557.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,930.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,546.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,546.30
|
| Rate for Payer: Multiplan Commercial |
$9,767.20
|
| Rate for Payer: Networks By Design Commercial |
$7,935.85
|
| Rate for Payer: Prime Health Services Commercial |
$10,377.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,325.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,325.40
|
| 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 |
$10,377.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,377.65
|
| Rate for Payer: Vantage Medical Group Senior |
$10,377.65
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$10,783.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,281.60 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,156.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cigna of CA HMO |
$7,008.95
|
| Rate for Payer: Cigna of CA PPO |
$7,979.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$9,165.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,469.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,281.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,192.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,587.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$8,626.40
|
| Rate for Payer: Networks By Design Commercial |
$7,008.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,165.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$11,095.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,219.00 |
| Max. Negotiated Rate |
$9,430.75 |
| Rate for Payer: Adventist Health Commercial |
$2,219.00
|
| Rate for Payer: Cash Price |
$6,102.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,438.00
|
| Rate for Payer: Galaxy Health WC |
$9,430.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,400.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,227.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,867.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,662.80
|
| Rate for Payer: Multiplan Commercial |
$8,876.00
|
| Rate for Payer: Networks By Design Commercial |
$7,211.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,430.75
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$10,783.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,156.60 |
| Max. Negotiated Rate |
$9,165.55 |
| Rate for Payer: Adventist Health Commercial |
$2,156.60
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,313.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,313.20
|
| Rate for Payer: Galaxy Health WC |
$9,165.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,469.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,192.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,108.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,674.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,587.92
|
| Rate for Payer: Multiplan Commercial |
$8,626.40
|
| Rate for Payer: Networks By Design Commercial |
$7,008.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,165.55
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$11,095.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,281.60 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,219.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$6,102.25
|
| Rate for Payer: Cash Price |
$6,102.25
|
| Rate for Payer: Cash Price |
$6,102.25
|
| Rate for Payer: Cigna of CA HMO |
$7,211.75
|
| Rate for Payer: Cigna of CA PPO |
$8,210.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$9,430.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,657.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,281.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,400.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,662.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$8,876.00
|
| Rate for Payer: Networks By Design Commercial |
$7,211.75
|
| Rate for Payer: Prime Health Services Commercial |
$9,430.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$583.95 |
| Rate for Payer: Adventist Health Commercial |
$137.40
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$274.80
|
| Rate for Payer: EPIC Health Plan Senior |
$274.80
|
| Rate for Payer: Galaxy Health WC |
$583.95
|
| Rate for Payer: Global Benefits Group Commercial |
$412.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$458.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$425.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.88
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: Networks By Design Commercial |
$446.55
|
| Rate for Payer: Prime Health Services Commercial |
$583.95
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.40 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$137.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cash Price |
$377.85
|
| Rate for Payer: Cigna of CA HMO |
$439.68
|
| Rate for Payer: Cigna of CA PPO |
$508.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$583.95
|
| Rate for Payer: Global Benefits Group Commercial |
$412.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$458.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$446.55
|
| Rate for Payer: Prime Health Services Commercial |
$583.95
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$412.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$343.50
|
| Rate for Payer: United Healthcare All Other HMO |
$343.50
|
| Rate for Payer: United Healthcare HMO Rider |
$343.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$343.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,178.64 |
| Max. Negotiated Rate |
$4,174.35 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,844.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,624.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,386.75
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,123.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,437.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,178.64 |
| Max. Negotiated Rate |
$4,174.35 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,844.45
|
| Rate for Payer: Blue Shield of California Commercial |
$3,624.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,386.75
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,123.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,437.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.64
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$950.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$454.56 |
| Max. Negotiated Rate |
$1,609.90 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,397.77
|
| Rate for Payer: Blue Shield of California EPN |
$920.48
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$950.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,515.20
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
915351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
915351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$707.76 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Adventist Health Commercial |
$1,209.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,211.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,708.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,176.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.21
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,506.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,378.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,064.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,064.30
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,506.65
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
905351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
905351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$707.76 |
| Max. Negotiated Rate |
$2,506.65 |
| Rate for Payer: Adventist Health Commercial |
$1,209.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,211.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,708.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2,176.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,433.21
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,506.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,378.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$707.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,064.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,064.30
|
| Rate for Payer: Multiplan Commercial |
$2,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,506.65
|
|
