|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$12,490.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906811409
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,498.00 |
| Max. Negotiated Rate |
$11,241.00 |
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,996.00
|
| Rate for Payer: Galaxy Health WC |
$10,616.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,494.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,241.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,758.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,498.00
|
| Rate for Payer: Multiplan Commercial |
$9,367.50
|
| Rate for Payer: Networks By Design Commercial |
$8,118.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,616.50
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
OP
|
$12,490.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$313.77 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,966.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,616.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,869.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,869.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,494.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,992.00
|
| Rate for Payer: Cigna of CA PPO |
$9,242.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,616.50
|
| Rate for Payer: Dignity Health Media |
$10,616.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,616.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,996.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,996.00
|
| Rate for Payer: Galaxy Health WC |
$10,616.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,494.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,241.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,367.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,371.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,498.00
|
| Rate for Payer: Multiplan Commercial |
$9,367.50
|
| Rate for Payer: Networks By Design Commercial |
$8,118.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,616.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,996.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,494.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,494.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,616.50
|
| Rate for Payer: Vantage Medical Group Senior |
$10,616.50
|
|
|
HC LEFT HEART CATH BY TRANSSEPTAL
|
Facility
|
IP
|
$12,490.00
|
|
|
Service Code
|
CPT 93462
|
| Hospital Charge Code |
906820067
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,498.00 |
| Max. Negotiated Rate |
$11,241.00 |
| Rate for Payer: Cash Price |
$5,620.50
|
| Rate for Payer: Central Health Plan Commercial |
$9,992.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,996.00
|
| Rate for Payer: Galaxy Health WC |
$10,616.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,494.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,241.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,758.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,498.00
|
| Rate for Payer: Multiplan Commercial |
$9,367.50
|
| Rate for Payer: Networks By Design Commercial |
$8,118.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,616.50
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,270.20 |
| Max. Negotiated Rate |
$10,215.90 |
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,080.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,540.40
|
| Rate for Payer: Galaxy Health WC |
$9,648.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,810.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,215.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,571.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,324.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,270.20
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
| Rate for Payer: Networks By Design Commercial |
$7,378.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,648.35
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906820058
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,449.43 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,239.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,810.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,080.80
|
| Rate for Payer: Cigna of CA PPO |
$8,399.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$9,648.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,810.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,215.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,513.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,571.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,270.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
| Rate for Payer: Networks By Design Commercial |
$7,378.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,648.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,810.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
OP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,449.43 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,239.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,810.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,080.80
|
| Rate for Payer: Cigna of CA PPO |
$8,399.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$9,648.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,810.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,215.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,513.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,571.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,449.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,270.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
| Rate for Payer: Networks By Design Commercial |
$7,378.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,648.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,810.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LEFT HEART CATH W/WO LV
|
Facility
|
IP
|
$11,351.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
906811399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,270.20 |
| Max. Negotiated Rate |
$10,215.90 |
| Rate for Payer: Cash Price |
$5,107.95
|
| Rate for Payer: Central Health Plan Commercial |
$9,080.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,540.40
|
| Rate for Payer: Galaxy Health WC |
$9,648.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,810.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,215.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,571.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,324.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,270.20
|
| Rate for Payer: Multiplan Commercial |
$8,513.25
|
| Rate for Payer: Networks By Design Commercial |
$7,378.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,648.35
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$587.40
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Central Health Plan Commercial |
$783.20
|
| Rate for Payer: Cigna of CA PPO |
$724.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$832.15
|
| Rate for Payer: Global Benefits Group Commercial |
$587.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$881.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$734.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$734.25
|
| Rate for Payer: Networks By Design Commercial |
$636.35
|
| Rate for Payer: Prime Health Services Commercial |
$832.15
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$587.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.50
|
| Rate for Payer: United Healthcare All Other HMO |
$489.50
|
| Rate for Payer: United Healthcare HMO Rider |
$489.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC LEG/ANKLE PROCEDURE UNLISTED
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 27899
|
| Hospital Charge Code |
900501440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$881.10 |
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Central Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.60
|
| Rate for Payer: Galaxy Health WC |
$832.15
|
| Rate for Payer: Global Benefits Group Commercial |
$587.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$881.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.80
|
| Rate for Payer: Multiplan Commercial |
$734.25
|
| Rate for Payer: Networks By Design Commercial |
$636.35
|
| Rate for Payer: Prime Health Services Commercial |
$832.15
|
|
|
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: Blue Shield of California EPN |
$2,622.47
|
| Rate for Payer: Cash Price |
$2,209.95
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$982.20
|
| 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: United Healthcare All Other Commercial |
$1,854.39
|
| Rate for Payer: United Healthcare All Other HMO |
$1,811.18
|
| Rate for Payer: United Healthcare HMO Rider |
$1,771.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,620.63
|
|
|
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 |
$1,718.85 |
| Max. Negotiated Rate |
$4,419.90 |
| 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 |
$2,701.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,377.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.42
|
| Rate for Payer: Blue Distinction Transplant |
$2,946.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,683.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,671.58
|
| Rate for Payer: Cash Price |
$2,209.95
|
| Rate for Payer: Cash Price |
$2,209.95
|
| 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 Media |
$4,174.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,174.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$3,683.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,718.85
|
| 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: LLUH Dept of Risk Management WC |
$2,013.51
|
| 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 |
$2,455.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,455.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,455.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,455.50
|
| 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 |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$662.90 |
| Max. Negotiated Rate |
$1,704.60 |
| 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 |
$1,041.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$917.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,118.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,136.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,420.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,030.34
|
| Rate for Payer: Cash Price |
$852.30
|
| Rate for Payer: Cash Price |
$852.30
|
| 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 Media |
$1,609.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,609.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$757.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,420.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$662.90
|
| 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: LLUH Dept of Risk Management WC |
$776.54
|
| 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 |
$947.00
|
| Rate for Payer: United Healthcare All Other HMO |
$947.00
|
| Rate for Payer: United Healthcare HMO Rider |
$947.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.00
|
| 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 |
905351755
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Blue Shield of California EPN |
$1,011.40
|
| Rate for Payer: Cash Price |
$852.30
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$378.80
|
| 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: United Healthcare All Other Commercial |
$715.17
|
| Rate for Payer: United Healthcare All Other HMO |
$698.51
|
| Rate for Payer: United Healthcare HMO Rider |
$683.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$625.02
|
|
|
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 |
$1,032.15 |
| Max. Negotiated Rate |
$2,654.10 |
| 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 |
$1,621.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,427.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,742.27
|
| Rate for Payer: Blue Distinction Transplant |
$1,769.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,211.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,604.26
|
| Rate for Payer: Cash Price |
$1,327.05
|
| Rate for Payer: Cash Price |
$1,327.05
|
| 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 Media |
$2,506.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,179.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,211.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,032.15
|
| 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: LLUH Dept of Risk Management WC |
$1,209.09
|
| 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 |
$1,474.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,474.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,474.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,474.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,506.65
|
|
|
HC LEGG PERTHES SCOTTISH RITE
|
Facility
|
IP
|
$2,949.00
|
|
|
Service Code
|
CPT L1730
|
| Hospital Charge Code |
905351730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$2,654.10 |
| Rate for Payer: Blue Shield of California EPN |
$1,574.77
|
| Rate for Payer: Cash Price |
$1,327.05
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$589.80
|
| 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: United Healthcare All Other Commercial |
$1,113.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,087.59
|
| Rate for Payer: United Healthcare HMO Rider |
$1,064.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$973.17
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
IP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$1,545.30 |
| Rate for Payer: Blue Shield of California EPN |
$916.88
|
| Rate for Payer: Cash Price |
$772.65
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$343.40
|
| 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: United Healthcare All Other Commercial |
$648.34
|
| Rate for Payer: United Healthcare All Other HMO |
$633.23
|
| Rate for Payer: United Healthcare HMO Rider |
$619.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$566.61
|
|
|
HC LEGG PERTHES TACHDIJAN TYPE
|
Facility
|
OP
|
$1,717.00
|
|
|
Service Code
|
CPT L1720
|
| Hospital Charge Code |
905351720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$600.95 |
| Max. Negotiated Rate |
$1,572.54 |
| 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 |
$944.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$831.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,014.40
|
| Rate for Payer: Blue Distinction Transplant |
$1,030.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,287.75
|
| Rate for Payer: Blue Shield of California EPN |
$934.05
|
| Rate for Payer: Cash Price |
$772.65
|
| Rate for Payer: Cash Price |
$772.65
|
| 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 Media |
$1,459.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,459.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,287.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$600.95
|
| 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: LLUH Dept of Risk Management WC |
$703.97
|
| 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 |
$858.50
|
| Rate for Payer: United Healthcare All Other HMO |
$858.50
|
| Rate for Payer: United Healthcare HMO Rider |
$858.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$858.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,459.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,459.45
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$931.40 |
| Max. Negotiated Rate |
$4,191.30 |
| Rate for Payer: Blue Shield of California EPN |
$2,486.84
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,725.60
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,191.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,774.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$931.40
|
| Rate for Payer: Multiplan Commercial |
$3,492.75
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,758.48
|
| Rate for Payer: United Healthcare All Other HMO |
$1,717.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,680.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,536.81
|
|
|
HC LEGG PERTHES TORONTO TYPE
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
CPT L1700
|
| Hospital Charge Code |
905351700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,616.48 |
| Max. Negotiated Rate |
$4,191.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,561.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,561.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,254.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,751.36
|
| Rate for Payer: Blue Distinction Transplant |
$2,794.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,492.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,533.41
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Cash Price |
$2,095.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,725.60
|
| Rate for Payer: Cigna of CA HMO |
$3,259.90
|
| Rate for Payer: Cigna of CA PPO |
$3,259.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,958.45
|
| Rate for Payer: Dignity Health Media |
$3,958.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,958.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,862.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,862.80
|
| Rate for Payer: Galaxy Health WC |
$3,958.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,794.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,191.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,492.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,629.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,106.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,616.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,909.37
|
| Rate for Payer: Multiplan Commercial |
$3,492.75
|
| Rate for Payer: Networks By Design Commercial |
$2,328.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,958.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,862.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,794.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,794.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,328.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,328.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,328.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,328.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,958.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,958.45
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
HC LE POLY KNEE CUSTOM KAFO ADDITION LE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L2387
|
| Hospital Charge Code |
905352387
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
IP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,933.40 |
| Max. Negotiated Rate |
$8,700.30 |
| Rate for Payer: Blue Shield of California EPN |
$5,162.18
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,733.60
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,700.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,683.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,933.40
|
| Rate for Payer: Multiplan Commercial |
$7,250.25
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,650.26
|
| Rate for Payer: United Healthcare All Other HMO |
$3,565.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3,487.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,190.11
|
|
|
HC LE SHANK FOOT SYSTM VERT LOAD
|
Facility
|
OP
|
$9,667.00
|
|
|
Service Code
|
CPT L5987
|
| Hospital Charge Code |
905355987
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,383.45 |
| Max. Negotiated Rate |
$8,700.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,316.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,316.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,680.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,711.26
|
| Rate for Payer: Blue Distinction Transplant |
$5,800.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,250.25
|
| Rate for Payer: Blue Shield of California EPN |
$5,258.85
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Cash Price |
$4,350.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,733.60
|
| Rate for Payer: Cigna of CA HMO |
$6,766.90
|
| Rate for Payer: Cigna of CA PPO |
$6,766.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,216.95
|
| Rate for Payer: Dignity Health Media |
$8,216.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,216.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,866.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,866.80
|
| Rate for Payer: Galaxy Health WC |
$8,216.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,800.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,700.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,250.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,383.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,447.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,971.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,963.47
|
| Rate for Payer: Multiplan Commercial |
$7,250.25
|
| Rate for Payer: Networks By Design Commercial |
$4,833.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,216.95
|
| Rate for Payer: Riverside University Health System MISP |
$3,866.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,800.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,833.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,833.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,833.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,833.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,216.95
|
| Rate for Payer: Vantage Medical Group Senior |
$8,216.95
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$1,772.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$673.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$52.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.62
|
| Rate for Payer: Blue Distinction Transplant |
$235.20
|
| Rate for Payer: Blue Shield of California Commercial |
$242.26
|
| Rate for Payer: Blue Shield of California EPN |
$190.51
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Central Health Plan Commercial |
$313.60
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$352.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$294.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: InnovAge PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC LEUK ACID PHOSP (TRAP STAIN)
|
Facility
|
IP
|
$1,080.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$216.00 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Cash Price |
$486.00
|
| Rate for Payer: Central Health Plan Commercial |
$864.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$432.00
|
| Rate for Payer: Galaxy Health WC |
$918.00
|
| Rate for Payer: Global Benefits Group Commercial |
$648.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$720.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.00
|
| Rate for Payer: Multiplan Commercial |
$810.00
|
| Rate for Payer: Networks By Design Commercial |
$702.00
|
| Rate for Payer: Prime Health Services Commercial |
$918.00
|
|
