|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
OP
|
$5,927.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,259.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,445.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$3,259.85
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: Cigna of CA HMO |
$3,793.28
|
| Rate for Payer: Cigna of CA PPO |
$4,385.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,037.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,148.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,148.90
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,556.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,963.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,037.95
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
IP
|
$5,927.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$5,037.95 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
OP
|
$5,927.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,259.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,445.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$3,259.85
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: Cigna of CA HMO |
$3,793.28
|
| Rate for Payer: Cigna of CA PPO |
$4,385.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,037.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,148.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,148.90
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,556.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,963.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,037.95
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
IP
|
$5,927.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$5,037.95 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Cash Price |
$3,259.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$35,043.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,008.60 |
| Max. Negotiated Rate |
$29,786.55 |
| Rate for Payer: Adventist Health Commercial |
$7,008.60
|
| Rate for Payer: Cash Price |
$19,273.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,017.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,017.20
|
| Rate for Payer: Galaxy Health WC |
$29,786.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,025.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,351.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,691.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,410.32
|
| Rate for Payer: Multiplan Commercial |
$28,034.40
|
| Rate for Payer: Networks By Design Commercial |
$22,777.95
|
| Rate for Payer: Prime Health Services Commercial |
$29,786.55
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$35,043.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.68 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,008.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| 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 |
$1,845.77
|
| Rate for Payer: Cash Price |
$19,273.65
|
| Rate for Payer: Cash Price |
$19,273.65
|
| Rate for Payer: Cash Price |
$19,273.65
|
| Rate for Payer: Cigna of CA HMO |
$22,427.52
|
| Rate for Payer: Cigna of CA PPO |
$25,931.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$29,786.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,025.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,410.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$28,034.40
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$22,777.95
|
| Rate for Payer: Prime Health Services Commercial |
$29,786.55
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,025.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC REVISION OF EYELID
|
Facility
|
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$749.80 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Adventist Health Commercial |
$749.80
|
| Rate for Payer: Cash Price |
$2,061.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,499.60
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,500.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,428.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,320.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.82 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Adventist Health Commercial |
$749.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$2,061.95
|
| Rate for Payer: Cash Price |
$2,061.95
|
| Rate for Payer: Cash Price |
$2,061.95
|
| Rate for Payer: Cigna of CA HMO |
$2,399.36
|
| Rate for Payer: Cigna of CA PPO |
$2,774.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,500.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,249.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,874.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,874.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,874.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,874.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
OP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,490.94 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,490.94
|
| Rate for Payer: Cash Price |
$26,666.20
|
| Rate for Payer: Cash Price |
$26,666.20
|
| Rate for Payer: Cash Price |
$26,666.20
|
| Rate for Payer: Cigna of CA HMO |
$31,029.76
|
| Rate for Payer: Cigna of CA PPO |
$35,878.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,338.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,636.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$38,787.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,090.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
IP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,696.80 |
| Max. Negotiated Rate |
$41,211.40 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Cash Price |
$26,666.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,393.60
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,338.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,472.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,011.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,636.16
|
| Rate for Payer: Multiplan Commercial |
$38,787.20
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$766.82 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: Cigna of CA HMO |
$4,012.80
|
| Rate for Payer: Cigna of CA PPO |
$4,639.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$766.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,762.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$5,329.50 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$3,448.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,508.00
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,881.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$1,872.55 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,211.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,652.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: Cigna of CA HMO |
$1,409.92
|
| Rate for Payer: Cigna of CA PPO |
$1,630.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,872.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,542.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,542.10
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,321.80
|
| 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 |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,872.55
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,211.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,652.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: Cigna of CA HMO |
$1,409.92
|
| Rate for Payer: Cigna of CA PPO |
$1,630.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,872.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,542.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,542.10
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,321.80
|
| 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 |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,872.55
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$1,872.55 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Cash Price |
$1,211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$3,083.80 |
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,451.20
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,382.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
|
|
HC RFA NERVE ROOT CERV THOR
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909064633
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$335.24 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: Cigna of CA HMO |
$2,321.92
|
| Rate for Payer: Cigna of CA PPO |
$2,684.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$335.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$3,083.80 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,451.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,451.20
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,382.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,245.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
|
|
HC RFA NERVE ROOT LUM SINGLE LEVEL
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
CPT 64635
|
| Hospital Charge Code |
909064635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$328.37 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$725.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: Cash Price |
$1,995.40
|
| Rate for Payer: Cigna of CA HMO |
$2,321.92
|
| Rate for Payer: Cigna of CA PPO |
$2,684.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$870.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$2,902.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
915352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,182.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
905352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$620.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,182.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
915352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$744.72 |
| Max. Negotiated Rate |
$2,637.55 |
| Rate for Payer: Adventist Health Commercial |
$1,272.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,706.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,327.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,797.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,290.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.06
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,637.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,637.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,119.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,172.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,172.10
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,861.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,861.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,637.55
|
|
|
HC RGO HIP JT AND CABLES, FRAME
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
CPT L2628
|
| Hospital Charge Code |
905352628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$744.72 |
| Max. Negotiated Rate |
$2,637.55 |
| Rate for Payer: Adventist Health Commercial |
$1,272.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,706.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,327.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,797.26
|
| Rate for Payer: Blue Shield of California Commercial |
$2,290.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.06
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cash Price |
$1,706.65
|
| Rate for Payer: Cigna of CA HMO |
$2,172.10
|
| Rate for Payer: Cigna of CA PPO |
$2,172.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,637.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,637.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,241.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,241.20
|
| Rate for Payer: Galaxy Health WC |
$2,637.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,861.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,119.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,069.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,920.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,172.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,172.10
|
| Rate for Payer: Multiplan Commercial |
$2,482.40
|
| Rate for Payer: Networks By Design Commercial |
$1,551.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,637.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,861.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,861.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,164.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1,133.53
|
| Rate for Payer: United Healthcare HMO Rider |
$1,109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,016.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,637.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,637.55
|
|
|
HC RGO HIP JT AND CABLES, MOLDED
|
Facility
|
IP
|
$2,938.00
|
|
|
Service Code
|
CPT L2627
|
| Hospital Charge Code |
905352627
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$587.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,615.90
|
| Rate for Payer: Cash Price |
$1,615.90
|
| Rate for Payer: Cigna of CA HMO |
$2,056.60
|
| Rate for Payer: Cigna of CA PPO |
$2,056.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.20
|
| Rate for Payer: Galaxy Health WC |
$2,497.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.12
|
| Rate for Payer: Multiplan Commercial |
$2,350.40
|
| Rate for Payer: Networks By Design Commercial |
$1,469.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,497.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.63
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.25
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.20
|
|
