|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$3,096.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$619.20 |
| Max. Negotiated Rate |
$2,786.40 |
| Rate for Payer: Adventist Health Commercial |
$619.20
|
| Rate for Payer: Cash Price |
$1,702.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,476.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,238.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,238.40
|
| Rate for Payer: Galaxy Health WC |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,786.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,179.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,916.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.20
|
| Rate for Payer: Multiplan Commercial |
$2,322.00
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,631.60
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
OP
|
$3,566.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$431.60 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,852.80
|
| Rate for Payer: Cigna of CA HMO |
$2,282.24
|
| Rate for Payer: Cigna of CA PPO |
$2,638.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,209.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$431.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,139.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
IP
|
$3,566.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.20 |
| Max. Negotiated Rate |
$3,209.40 |
| Rate for Payer: Adventist Health Commercial |
$713.20
|
| Rate for Payer: Cash Price |
$1,961.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,852.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,426.40
|
| Rate for Payer: Galaxy Health WC |
$3,031.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,139.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,209.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,378.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,358.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,207.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.20
|
| Rate for Payer: Multiplan Commercial |
$2,674.50
|
| Rate for Payer: Networks By Design Commercial |
$2,317.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,031.10
|
|
|
HC EGFR
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$320.40 |
| Rate for Payer: Adventist Health Commercial |
$71.20
|
| Rate for Payer: Cash Price |
$195.80
|
| Rate for Payer: Central Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Senior |
$142.40
|
| Rate for Payer: Galaxy Health WC |
$302.60
|
| Rate for Payer: Global Benefits Group Commercial |
$213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$220.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
| Rate for Payer: Networks By Design Commercial |
$231.40
|
| Rate for Payer: Prime Health Services Commercial |
$302.60
|
|
|
HC EGFR
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 81235
|
| Hospital Charge Code |
903800314
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$532.31 |
| Rate for Payer: Adventist Health Commercial |
$71.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$324.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$216.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.81
|
| Rate for Payer: Blue Shield of California Commercial |
$216.09
|
| Rate for Payer: Blue Shield of California EPN |
$141.33
|
| Rate for Payer: Cash Price |
$195.80
|
| Rate for Payer: Cash Price |
$195.80
|
| Rate for Payer: Central Health Plan Commercial |
$284.80
|
| Rate for Payer: Cigna of CA HMO |
$227.84
|
| Rate for Payer: Cigna of CA PPO |
$263.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$486.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$324.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.18
|
| Rate for Payer: EPIC Health Plan Senior |
$324.58
|
| Rate for Payer: Galaxy Health WC |
$302.60
|
| Rate for Payer: Global Benefits Group Commercial |
$213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$532.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$324.58
|
| Rate for Payer: InnovAge PACE Commercial |
$486.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$324.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$434.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$434.94
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
| Rate for Payer: Networks By Design Commercial |
$231.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$324.58
|
| Rate for Payer: Prime Health Services Commercial |
$302.60
|
| Rate for Payer: Prime Health Services Medicare |
$344.05
|
| Rate for Payer: Riverside University Health System MISP |
$357.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.91
|
| Rate for Payer: United Healthcare All Other HMO |
$262.91
|
| Rate for Payer: United Healthcare HMO Rider |
$262.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$324.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$486.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.04
|
| Rate for Payer: Vantage Medical Group Senior |
$324.58
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
OP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$6,033.60 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,687.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,028.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,182.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,378.82
|
| Rate for Payer: Cash Price |
$3,687.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,363.20
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,698.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,033.60
|
| Rate for Payer: InnovAge PACE Commercial |
$3,352.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,149.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,692.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,692.80
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: Riverside University Health System MISP |
$2,681.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,022.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,022.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,516.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,396.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,698.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,698.40
|
|
|
HC EKOS THROMLYSIS CATH
|
Facility
|
IP
|
$6,704.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909081018
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$6,033.60 |
| Rate for Payer: Adventist Health Commercial |
$1,340.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,182.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,378.82
|
| Rate for Payer: Cash Price |
$3,687.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,363.20
|
| Rate for Payer: Cigna of CA HMO |
$4,692.80
|
| Rate for Payer: Cigna of CA PPO |
$4,692.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,681.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,681.60
|
| Rate for Payer: Galaxy Health WC |
$5,698.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,022.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,033.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,471.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,554.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,149.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,340.80
|
| Rate for Payer: Multiplan Commercial |
$5,028.00
|
| Rate for Payer: Networks By Design Commercial |
$3,352.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,698.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,516.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,396.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,195.56
|
|
|
HC ELASTIC WITH STAYS
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT L3700
|
| Hospital Charge Code |
903203700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$79.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: InnovAge PACE Commercial |
$97.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$97.00
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Riverside University Health System MISP |
$77.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC ELASTIC WITH STAYS
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT L3700
|
| Hospital Charge Code |
903203700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Blue Shield of California Commercial |
$149.96
|
| Rate for Payer: Blue Shield of California EPN |
$97.78
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$135.80
|
| Rate for Payer: Cigna of CA PPO |
$135.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.81
|
| Rate for Payer: United Healthcare All Other HMO |
$70.87
|
| Rate for Payer: United Healthcare HMO Rider |
$69.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.53
|
|
|
HC ELASTOPLAST
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
|
|
HC ELASTOPLAST
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
909001032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$4.79
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: InnovAge PACE Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Riverside University Health System MISP |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$369.90 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$351.55
|
| Rate for Payer: InnovAge PACE Commercial |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Riverside University Health System MISP |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| 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 |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Riverside University Health System MISP |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$205.50
|
| Rate for Payer: United Healthcare All Other HMO |
$205.50
|
| Rate for Payer: United Healthcare HMO Rider |
$205.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$205.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC ELBOW COMPLETE
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.60 |
| Max. Negotiated Rate |
$1,114.20 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Cash Price |
$680.90
|
| Rate for Payer: Central Health Plan Commercial |
$990.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Senior |
$495.20
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,114.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$766.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.60
|
| Rate for Payer: Multiplan Commercial |
$928.50
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
|
|
HC ELBOW COMPLETE
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$1,114.20 |
| Rate for Payer: Adventist Health Commercial |
$247.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.09
|
| Rate for Payer: Blue Shield of California Commercial |
$751.47
|
| Rate for Payer: Blue Shield of California EPN |
$491.49
|
| Rate for Payer: Cash Price |
$680.90
|
| Rate for Payer: Cash Price |
$680.90
|
| Rate for Payer: Central Health Plan Commercial |
$990.40
|
| Rate for Payer: Cigna of CA HMO |
$792.32
|
| Rate for Payer: Cigna of CA PPO |
$916.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,052.30
|
| Rate for Payer: Global Benefits Group Commercial |
$742.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,114.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$928.50
|
| Rate for Payer: Networks By Design Commercial |
$804.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,052.30
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$742.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$742.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$531.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$531.12
|
| Rate for Payer: Blue Shield of California EPN |
$347.38
|
| Rate for Payer: Cash Price |
$481.25
|
| Rate for Payer: Cash Price |
$481.25
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: Cigna of CA HMO |
$560.00
|
| Rate for Payer: Cigna of CA PPO |
$647.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.00 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$175.00
|
| Rate for Payer: Cash Price |
$481.25
|
| Rate for Payer: Central Health Plan Commercial |
$700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$350.00
|
| Rate for Payer: Galaxy Health WC |
$743.75
|
| Rate for Payer: Global Benefits Group Commercial |
$525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$787.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$583.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$656.25
|
| Rate for Payer: Networks By Design Commercial |
$568.75
|
| Rate for Payer: Prime Health Services Commercial |
$743.75
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
915356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$336.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,300.96
|
| Rate for Payer: Blue Shield of California EPN |
$848.23
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,346.40
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,514.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.60
|
| Rate for Payer: Multiplan Commercial |
$1,262.25
|
| Rate for Payer: Networks By Design Commercial |
$1,093.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
905356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$551.18 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$690.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,262.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$988.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,300.96
|
| Rate for Payer: Blue Shield of California EPN |
$848.23
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,346.40
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,430.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,430.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,514.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.70
|
| Rate for Payer: InnovAge PACE Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,178.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,178.10
|
| Rate for Payer: Multiplan Commercial |
$1,262.25
|
| Rate for Payer: Networks By Design Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: Riverside University Health System MISP |
$673.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,430.55
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
915356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$551.18 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$690.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$925.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,262.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$988.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,300.96
|
| Rate for Payer: Blue Shield of California EPN |
$848.23
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,346.40
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,430.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,430.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,514.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$864.70
|
| Rate for Payer: InnovAge PACE Commercial |
$841.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$955.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,178.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,178.10
|
| Rate for Payer: Multiplan Commercial |
$1,262.25
|
| Rate for Payer: Networks By Design Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: Riverside University Health System MISP |
$673.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,430.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,430.55
|
|
|
HC ELBOW SOCKET INS USE W/LOCK
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT L6694
|
| Hospital Charge Code |
905356694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$336.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,300.96
|
| Rate for Payer: Blue Shield of California EPN |
$848.23
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,346.40
|
| Rate for Payer: Cigna of CA HMO |
$1,178.10
|
| Rate for Payer: Cigna of CA PPO |
$1,178.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.20
|
| Rate for Payer: EPIC Health Plan Senior |
$673.20
|
| Rate for Payer: Galaxy Health WC |
$1,430.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,514.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,041.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.60
|
| Rate for Payer: Multiplan Commercial |
$1,262.25
|
| Rate for Payer: Networks By Design Commercial |
$1,093.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,430.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$631.63
|
| Rate for Payer: United Healthcare All Other HMO |
$614.80
|
| Rate for Payer: United Healthcare HMO Rider |
$601.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.18
|
|
|
HC ELBOW SOCKET INS USE W/O LCK
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L6695
|
| Hospital Charge Code |
905356695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Blue Shield of California Commercial |
$867.31
|
| Rate for Payer: Blue Shield of California EPN |
$565.49
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.40
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$729.30
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
|
|
HC ELBOW SOCKET INS USE W/O LCK
|
Facility
|
IP
|
$1,122.00
|
|
|
Service Code
|
CPT L6695
|
| Hospital Charge Code |
915356695
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$224.40 |
| Max. Negotiated Rate |
$1,009.80 |
| Rate for Payer: Adventist Health Commercial |
$224.40
|
| Rate for Payer: Blue Shield of California Commercial |
$867.31
|
| Rate for Payer: Blue Shield of California EPN |
$565.49
|
| Rate for Payer: Cash Price |
$617.10
|
| Rate for Payer: Central Health Plan Commercial |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$785.40
|
| Rate for Payer: Cigna of CA PPO |
$785.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.80
|
| Rate for Payer: EPIC Health Plan Senior |
$448.80
|
| Rate for Payer: Galaxy Health WC |
$953.70
|
| Rate for Payer: Global Benefits Group Commercial |
$673.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,009.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$748.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$694.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.40
|
| Rate for Payer: Multiplan Commercial |
$841.50
|
| Rate for Payer: Networks By Design Commercial |
$729.30
|
| Rate for Payer: Prime Health Services Commercial |
$953.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$421.09
|
| Rate for Payer: United Healthcare All Other HMO |
$409.87
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$367.45
|
|
