|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$608.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$663.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Central Health Plan Commercial |
$884.80
|
| Rate for Payer: Cigna of CA PPO |
$818.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.10
|
| Rate for Payer: Dignity Health Media |
$940.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.40
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$995.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$829.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$387.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.20
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
| Rate for Payer: Riverside University Health System MISP |
$442.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.10
|
| Rate for Payer: Vantage Medical Group Senior |
$940.10
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
906820178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$608.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$663.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Central Health Plan Commercial |
$884.80
|
| Rate for Payer: Cigna of CA PPO |
$818.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.10
|
| Rate for Payer: Dignity Health Media |
$940.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$442.40
|
| Rate for Payer: Galaxy Health WC |
$940.10
|
| Rate for Payer: Global Benefits Group Commercial |
$663.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$995.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$829.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$387.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.20
|
| Rate for Payer: Multiplan Commercial |
$829.50
|
| Rate for Payer: Networks By Design Commercial |
$718.90
|
| Rate for Payer: Prime Health Services Commercial |
$940.10
|
| Rate for Payer: Riverside University Health System MISP |
$442.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.10
|
| Rate for Payer: Vantage Medical Group Senior |
$940.10
|
|
|
HC ARTERIAL CATHETERIZATION KIT
|
Facility
|
IP
|
$423.23
|
|
| Hospital Charge Code |
901698288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.65 |
| Max. Negotiated Rate |
$380.91 |
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Central Health Plan Commercial |
$338.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.29
|
| Rate for Payer: Galaxy Health WC |
$359.75
|
| Rate for Payer: Global Benefits Group Commercial |
$253.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.65
|
| Rate for Payer: Multiplan Commercial |
$317.42
|
| Rate for Payer: Networks By Design Commercial |
$275.10
|
| Rate for Payer: Prime Health Services Commercial |
$359.75
|
|
|
HC ARTERIAL CATHETERIZATION KIT
|
Facility
|
OP
|
$423.23
|
|
| Hospital Charge Code |
901698288
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.65 |
| Max. Negotiated Rate |
$380.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$257.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$359.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$232.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$204.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.04
|
| Rate for Payer: Blue Distinction Transplant |
$253.94
|
| Rate for Payer: Blue Shield of California Commercial |
$266.21
|
| Rate for Payer: Blue Shield of California EPN |
$206.96
|
| Rate for Payer: Cash Price |
$190.45
|
| Rate for Payer: Central Health Plan Commercial |
$338.58
|
| Rate for Payer: Cigna of CA HMO |
$270.87
|
| Rate for Payer: Cigna of CA PPO |
$313.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$359.75
|
| Rate for Payer: Dignity Health Media |
$359.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$359.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.29
|
| Rate for Payer: Galaxy Health WC |
$359.75
|
| Rate for Payer: Global Benefits Group Commercial |
$253.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$317.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$282.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$161.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.65
|
| Rate for Payer: Multiplan Commercial |
$317.42
|
| Rate for Payer: Networks By Design Commercial |
$275.10
|
| Rate for Payer: Prime Health Services Commercial |
$359.75
|
| Rate for Payer: Riverside University Health System MISP |
$169.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$211.62
|
| Rate for Payer: United Healthcare All Other HMO |
$211.62
|
| Rate for Payer: United Healthcare HMO Rider |
$211.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$211.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$359.75
|
| Rate for Payer: Vantage Medical Group Senior |
$359.75
|
|
|
HC ARTERIAL LINE INSERTION KIT
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC ARTERIAL LINE INSERTION KIT
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698279
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$648.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: Cigna of CA PPO |
$799.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Media |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$810.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
| Rate for Payer: Riverside University Health System MISP |
$432.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$648.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: Cigna of CA PPO |
$799.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Media |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$810.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
| Rate for Payer: Riverside University Health System MISP |
$432.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.20 |
| Max. Negotiated Rate |
$972.90 |
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$216.20 |
| Max. Negotiated Rate |
$972.90 |
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.93 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$648.60
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: Cigna of CA PPO |
$799.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Media |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$810.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
| Rate for Payer: Riverside University Health System MISP |
$432.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$648.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$540.50
|
| Rate for Payer: United Healthcare All Other HMO |
$540.50
|
| Rate for Payer: United Healthcare HMO Rider |
$540.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$540.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
906820099
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.20 |
| Max. Negotiated Rate |
$972.90 |
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Central Health Plan Commercial |
$864.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.40
|
| Rate for Payer: Galaxy Health WC |
$918.85
|
| Rate for Payer: Global Benefits Group Commercial |
$648.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$721.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: Networks By Design Commercial |
$702.65
|
| Rate for Payer: Prime Health Services Commercial |
$918.85
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,369.00 |
| Max. Negotiated Rate |
$10,660.50 |
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,738.00
|
| Rate for Payer: Galaxy Health WC |
$10,068.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,107.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,660.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,900.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,512.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,369.00
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
| Rate for Payer: Networks By Design Commercial |
$7,699.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,068.25
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$2,369.00 |
| Max. Negotiated Rate |
$10,660.50 |
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,738.00
|
| Rate for Payer: Galaxy Health WC |
$10,068.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,107.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,660.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,900.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,512.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,369.00
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
| Rate for Payer: Networks By Design Commercial |
$7,699.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,068.25
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$245.76 |
| Max. Negotiated Rate |
$11,329.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$980.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: Blue Distinction Transplant |
$7,107.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,320.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,756.67
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,476.00
|
| Rate for Payer: Cigna of CA HMO |
$7,580.80
|
| Rate for Payer: Cigna of CA PPO |
$8,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$10,068.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,107.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,660.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,883.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,900.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,369.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
| Rate for Payer: Networks By Design Commercial |
$7,699.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,068.25
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,107.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,107.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$11,845.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
906820193
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$245.76 |
| Max. Negotiated Rate |
$11,329.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$6,866.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$980.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,199.02
|
| Rate for Payer: Blue Distinction Transplant |
$7,107.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,320.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,756.67
|
| Rate for Payer: Caremore Medicare Advantage |
$6,866.07
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Cash Price |
$5,330.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,476.00
|
| Rate for Payer: Cigna of CA HMO |
$7,580.80
|
| Rate for Payer: Cigna of CA PPO |
$8,765.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$10,068.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,107.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,660.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,883.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,329.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: InnovAge PACE Commercial |
$10,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,900.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$245.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,369.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,200.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$8,883.75
|
| Rate for Payer: Networks By Design Commercial |
$7,699.25
|
| Rate for Payer: Prime Health Services Commercial |
$10,068.25
|
| Rate for Payer: Prime Health Services Medicare |
$7,278.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,552.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,107.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,107.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$743.40
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Central Health Plan Commercial |
$991.20
|
| Rate for Payer: Cigna of CA PPO |
$916.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,053.15
|
| Rate for Payer: Global Benefits Group Commercial |
$743.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,115.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$929.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Networks By Design Commercial |
$805.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,053.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$743.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$619.50
|
| Rate for Payer: United Healthcare All Other HMO |
$619.50
|
| Rate for Payer: United Healthcare HMO Rider |
$619.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$619.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$743.40
|
| Rate for Payer: Blue Shield of California Commercial |
$779.33
|
| Rate for Payer: Blue Shield of California EPN |
$605.87
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Central Health Plan Commercial |
$991.20
|
| Rate for Payer: Cigna of CA HMO |
$792.96
|
| Rate for Payer: Cigna of CA PPO |
$916.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,053.15
|
| Rate for Payer: Global Benefits Group Commercial |
$743.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,115.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$929.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Networks By Design Commercial |
$805.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,053.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$743.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$743.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$619.50
|
| Rate for Payer: United Healthcare All Other HMO |
$619.50
|
| Rate for Payer: United Healthcare HMO Rider |
$619.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$619.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Central Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.60
|
| Rate for Payer: Galaxy Health WC |
$1,053.15
|
| Rate for Payer: Global Benefits Group Commercial |
$743.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,115.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.80
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Networks By Design Commercial |
$805.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,053.15
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Central Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.60
|
| Rate for Payer: Galaxy Health WC |
$1,053.15
|
| Rate for Payer: Global Benefits Group Commercial |
$743.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,115.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.80
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Networks By Design Commercial |
$805.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,053.15
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
OP
|
$1,239.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$743.40
|
| Rate for Payer: Blue Shield of California Commercial |
$779.33
|
| Rate for Payer: Blue Shield of California EPN |
$605.87
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Central Health Plan Commercial |
$991.20
|
| Rate for Payer: Cigna of CA HMO |
$792.96
|
| Rate for Payer: Cigna of CA PPO |
$916.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,053.15
|
| Rate for Payer: Global Benefits Group Commercial |
$743.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,115.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$929.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Networks By Design Commercial |
$805.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,053.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$743.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$743.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$619.50
|
| Rate for Payer: United Healthcare All Other HMO |
$619.50
|
| Rate for Payer: United Healthcare HMO Rider |
$619.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$619.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$1,239.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$247.80 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: Cash Price |
$557.55
|
| Rate for Payer: Central Health Plan Commercial |
$991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.60
|
| Rate for Payer: Galaxy Health WC |
$1,053.15
|
| Rate for Payer: Global Benefits Group Commercial |
$743.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,115.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$826.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.80
|
| Rate for Payer: Multiplan Commercial |
$929.25
|
| Rate for Payer: Networks By Design Commercial |
$805.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,053.15
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$267.80 |
| Max. Negotiated Rate |
$1,205.10 |
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,071.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.60
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,205.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.80
|
| Rate for Payer: Multiplan Commercial |
$1,004.25
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$803.40
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,071.20
|
| Rate for Payer: Cigna of CA PPO |
$990.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,205.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,004.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,004.25
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$803.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$803.40
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Cash Price |
$602.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,071.20
|
| Rate for Payer: Cigna of CA PPO |
$990.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,138.15
|
| Rate for Payer: Global Benefits Group Commercial |
$803.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,205.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,004.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,004.25
|
| Rate for Payer: Networks By Design Commercial |
$870.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$803.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$669.50
|
| Rate for Payer: United Healthcare All Other HMO |
$669.50
|
| Rate for Payer: United Healthcare HMO Rider |
$669.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
