|
HC LEFT ATRIAL APPENDAGE CLOSURE
|
Facility
|
OP
|
$78,157.00
|
|
|
Service Code
|
CPT 33340
|
| Hospital Charge Code |
906820337
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.36 |
| Max. Negotiated Rate |
$70,341.30 |
| Rate for Payer: Adventist Health Commercial |
$15,631.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42,986.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58,617.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,227.69
|
| Rate for Payer: Blue Shield of California EPN |
$6,020.76
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Cash Price |
$42,986.35
|
| Rate for Payer: Central Health Plan Commercial |
$62,525.60
|
| Rate for Payer: Cigna of CA HMO |
$50,020.48
|
| Rate for Payer: Cigna of CA PPO |
$57,836.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$66,433.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$66,433.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$31,262.80
|
| Rate for Payer: Galaxy Health WC |
$66,433.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46,894.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$70,341.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,167.36
|
| Rate for Payer: InnovAge PACE Commercial |
$39,078.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,130.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,289.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48,379.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,631.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$54,709.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54,709.90
|
| Rate for Payer: Multiplan Commercial |
$58,617.75
|
| Rate for Payer: Networks By Design Commercial |
$50,802.05
|
| Rate for Payer: Prime Health Services Commercial |
$66,433.45
|
| Rate for Payer: Riverside University Health System MISP |
$31,262.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46,894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66,433.45
|
| Rate for Payer: Vantage Medical Group Senior |
$66,433.45
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$10,086.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,017.20 |
| Max. Negotiated Rate |
$9,077.40 |
| Rate for Payer: Adventist Health Commercial |
$2,017.20
|
| Rate for Payer: Cash Price |
$5,547.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,068.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,034.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,034.40
|
| Rate for Payer: Galaxy Health WC |
$8,573.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,051.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,077.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,727.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,842.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,243.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,017.20
|
| Rate for Payer: Multiplan Commercial |
$7,564.50
|
| Rate for Payer: Networks By Design Commercial |
$6,555.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,573.10
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$11,866.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,373.20 |
| Max. Negotiated Rate |
$10,679.40 |
| Rate for Payer: Adventist Health Commercial |
$2,373.20
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,746.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,746.40
|
| Rate for Payer: Galaxy Health WC |
$10,086.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,119.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,679.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,914.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,520.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,345.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.20
|
| Rate for Payer: Multiplan Commercial |
$8,899.50
|
| Rate for Payer: Networks By Design Commercial |
$7,712.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,086.10
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$10,086.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$284.04 |
| Max. Negotiated Rate |
$9,077.40 |
| Rate for Payer: Adventist Health Commercial |
$2,017.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,573.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,547.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,564.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,883.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,923.51
|
| 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 |
$5,547.30
|
| Rate for Payer: Cash Price |
$5,547.30
|
| Rate for Payer: Cash Price |
$5,547.30
|
| Rate for Payer: Central Health Plan Commercial |
$8,068.80
|
| Rate for Payer: Cigna of CA HMO |
$6,555.90
|
| Rate for Payer: Cigna of CA PPO |
$7,463.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,573.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,573.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,573.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,034.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,034.40
|
| Rate for Payer: Galaxy Health WC |
$8,573.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,051.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,077.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.04
|
| Rate for Payer: InnovAge PACE Commercial |
$5,043.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,727.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,243.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,017.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,060.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,060.20
|
| Rate for Payer: Multiplan Commercial |
$7,564.50
|
| Rate for Payer: Networks By Design Commercial |
$6,555.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,573.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,034.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,051.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,051.60
|
| 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 |
$8,573.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,573.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,573.10
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$11,866.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$284.04 |
| Max. Negotiated Rate |
$10,679.40 |
| Rate for Payer: Adventist Health Commercial |
$2,373.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,086.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,526.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,899.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,745.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,968.90
|
| 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 |
$6,526.30
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Cash Price |
$6,526.30
|
| Rate for Payer: Central Health Plan Commercial |
$9,492.80
|
| Rate for Payer: Cigna of CA HMO |
$7,712.90
|
| Rate for Payer: Cigna of CA PPO |
$8,780.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,086.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,086.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,086.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,746.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,746.40
|
| Rate for Payer: Galaxy Health WC |
$10,086.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,119.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,679.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.04
|
| Rate for Payer: InnovAge PACE Commercial |
$5,933.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,914.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,345.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,373.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,306.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,306.20
|
| Rate for Payer: Multiplan Commercial |
$8,899.50
|
| Rate for Payer: Networks By Design Commercial |
$7,712.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,086.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,746.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,119.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,119.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,086.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,086.10
|
| Rate for Payer: Vantage Medical Group Senior |
$10,086.10
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$9,166.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,833.20 |
| Max. Negotiated Rate |
$8,249.40 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,332.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,666.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,666.40
|
| Rate for Payer: Galaxy Health WC |
$7,791.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,499.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,249.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,113.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,492.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,673.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,833.20
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
| Rate for Payer: Networks By Design Commercial |
$5,957.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,791.10
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$10,783.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,312.12 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,156.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,626.40
|
| Rate for Payer: Cigna of CA HMO |
$7,008.95
|
| Rate for Payer: Cigna of CA PPO |
$7,979.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$9,165.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,704.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,312.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,192.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,156.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$8,087.25
|
| Rate for Payer: Networks By Design Commercial |
$7,008.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$9,165.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,469.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$10,783.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,156.60 |
| Max. Negotiated Rate |
$9,704.70 |
| Rate for Payer: Adventist Health Commercial |
$2,156.60
|
| Rate for Payer: Cash Price |
$5,930.65
|
| Rate for Payer: Central Health Plan Commercial |
$8,626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,313.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,313.20
|
| Rate for Payer: Galaxy Health WC |
$9,165.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,192.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,108.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,674.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,156.60
|
| Rate for Payer: Multiplan Commercial |
$8,087.25
|
| Rate for Payer: Networks By Design Commercial |
$7,008.95
|
| Rate for Payer: Prime Health Services Commercial |
$9,165.55
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$9,166.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,312.12 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$1,833.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Cash Price |
$5,041.30
|
| Rate for Payer: Central Health Plan Commercial |
$7,332.80
|
| Rate for Payer: Cigna of CA HMO |
$5,957.90
|
| Rate for Payer: Cigna of CA PPO |
$6,782.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$7,791.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,499.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,249.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,312.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,113.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,833.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$6,874.50
|
| Rate for Payer: Networks By Design Commercial |
$5,957.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$7,791.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,499.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| 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 |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: Cigna of CA HMO |
$828.80
|
| Rate for Payer: Cigna of CA PPO |
$958.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.50
|
| Rate for Payer: United Healthcare All Other HMO |
$647.50
|
| Rate for Payer: United Healthcare HMO Rider |
$647.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$647.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Cash Price |
$712.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.00
|
| Rate for Payer: EPIC Health Plan Senior |
$518.00
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$863.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$801.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,608.35 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,884.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,796.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,173.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2,455.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,437.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,964.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
905351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,796.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.20
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$3,192.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
IP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$982.20 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$982.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,796.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.20
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$3,192.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
|
|
HC LEGG PERTHES, NEWINGTON TYPE
|
Facility
|
OP
|
$4,911.00
|
|
|
Service Code
|
CPT L1710
|
| Hospital Charge Code |
915351710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,608.35 |
| Max. Negotiated Rate |
$4,419.90 |
| Rate for Payer: Adventist Health Commercial |
$2,013.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,701.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,683.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,884.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,796.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,475.14
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Cash Price |
$2,701.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,928.80
|
| Rate for Payer: Cigna of CA HMO |
$3,437.70
|
| Rate for Payer: Cigna of CA PPO |
$3,437.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,174.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.40
|
| Rate for Payer: Galaxy Health WC |
$4,174.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,946.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,419.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,173.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2,455.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,401.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,013.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,437.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,437.70
|
| Rate for Payer: Multiplan Commercial |
$3,683.25
|
| Rate for Payer: Networks By Design Commercial |
$2,455.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,174.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,964.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,946.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,946.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,843.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,793.99
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,608.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,174.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,174.35
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,112.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.28
|
| Rate for Payer: InnovAge PACE Commercial |
$947.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Riverside University Health System MISP |
$757.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
915351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$378.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$721.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$1,231.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
|
|
HC LEGG PERTHES PATTEN BOTTOM TY
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT L1755
|
| Hospital Charge Code |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$620.28 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Adventist Health Commercial |
$776.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,041.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,420.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,112.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,464.06
|
| Rate for Payer: Blue Shield of California EPN |
$954.58
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Cash Price |
$1,041.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,515.20
|
| Rate for Payer: Cigna of CA HMO |
$1,325.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Senior |
$757.60
|
| Rate for Payer: Galaxy Health WC |
$1,609.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,136.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,704.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.28
|
| Rate for Payer: InnovAge PACE Commercial |
$947.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,263.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,075.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,172.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$776.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,325.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,325.80
|
| Rate for Payer: Multiplan Commercial |
$1,420.50
|
| Rate for Payer: Networks By Design Commercial |
$947.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,609.90
|
| Rate for Payer: Riverside University Health System MISP |
$757.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,136.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,136.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$710.82
|
| Rate for Payer: United Healthcare All Other HMO |
$691.88
|
| Rate for Payer: United Healthcare HMO Rider |
$676.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$620.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,609.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,609.90
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
905351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$2,654.10 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,279.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.30
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,359.20
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,654.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.80
|
| Rate for Payer: Multiplan Commercial |
$2,211.75
|
| Rate for Payer: Networks By Design Commercial |
$1,916.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
915351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$965.80 |
| Max. Negotiated Rate |
$2,654.10 |
| Rate for Payer: Adventist Health Commercial |
$1,209.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,211.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,731.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2,279.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.30
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,359.20
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,506.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,654.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,411.60
|
| Rate for Payer: InnovAge PACE Commercial |
$1,474.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,209.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,064.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,064.30
|
| Rate for Payer: Multiplan Commercial |
$2,211.75
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,506.65
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
915351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$2,654.10 |
| Rate for Payer: Adventist Health Commercial |
$589.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,279.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.30
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,359.20
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,654.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,123.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.80
|
| Rate for Payer: Multiplan Commercial |
$2,211.75
|
| Rate for Payer: Networks By Design Commercial |
$1,916.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
OP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
905351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$965.80 |
| Max. Negotiated Rate |
$2,654.10 |
| Rate for Payer: Adventist Health Commercial |
$1,209.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,211.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,731.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2,279.58
|
| Rate for Payer: Blue Shield of California EPN |
$1,486.30
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Cash Price |
$1,621.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,359.20
|
| Rate for Payer: Cigna of CA HMO |
$2,064.30
|
| Rate for Payer: Cigna of CA PPO |
$2,064.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,506.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,179.60
|
| Rate for Payer: Galaxy Health WC |
$2,506.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,769.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,654.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,411.60
|
| Rate for Payer: InnovAge PACE Commercial |
$1,474.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,966.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,559.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,825.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,209.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,064.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,064.30
|
| Rate for Payer: Multiplan Commercial |
$2,211.75
|
| Rate for Payer: Networks By Design Commercial |
$1,474.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,506.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,179.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,769.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,106.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1,077.27
|
| Rate for Payer: United Healthcare HMO Rider |
$1,053.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,506.65
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
915351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.32 |
| Max. Negotiated Rate |
$1,572.54 |
| Rate for Payer: Adventist Health Commercial |
$703.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$944.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,287.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,008.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,423.56
|
| Rate for Payer: InnovAge PACE Commercial |
$858.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,572.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$703.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,201.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.90
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$858.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: Riverside University Health System MISP |
$686.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,030.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,030.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
915351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Adventist Health Commercial |
$343.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,327.24
|
| Rate for Payer: Blue Shield of California EPN |
$865.37
|
| Rate for Payer: Cash Price |
$944.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,373.60
|
| Rate for Payer: Cigna of CA HMO |
$1,201.90
|
| Rate for Payer: Cigna of CA PPO |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Senior |
$686.80
|
| Rate for Payer: Galaxy Health WC |
$1,459.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,030.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,545.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,062.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.40
|
| Rate for Payer: Multiplan Commercial |
$1,287.75
|
| Rate for Payer: Networks By Design Commercial |
$1,116.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,459.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$644.39
|
| Rate for Payer: United Healthcare All Other HMO |
$627.22
|
| Rate for Payer: United Healthcare HMO Rider |
$613.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$562.32
|
|
