|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
OP
|
$1,006.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$621.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$553.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$754.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$653.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$855.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$855.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.71
|
| Rate for Payer: Heritage Provider Network Senior |
$622.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$479.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$704.20
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$855.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.10
|
| Rate for Payer: Vantage Medical Group Senior |
$855.10
|
|
|
HC ARTERIAL, 2ND ORDER CATH PL
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
909081320
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$182.09 |
| Max. Negotiated Rate |
$754.50 |
| Rate for Payer: Adventist Health Commercial |
$201.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$647.86
|
| Rate for Payer: Cash Price |
$452.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$681.06
|
| Rate for Payer: Heritage Provider Network Senior |
$681.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$251.50
|
| Rate for Payer: Multiplan Commercial |
$754.50
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.66 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$668.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$594.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$810.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$702.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$918.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$918.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$918.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$669.14
|
| Rate for Payer: Heritage Provider Network Senior |
$669.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$515.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$756.70
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$918.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$918.85
|
| Rate for Payer: Vantage Medical Group Senior |
$918.85
|
|
|
HC ARTERIAL, 3RD ORDER CATH PL
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
909081321
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$195.66 |
| Max. Negotiated Rate |
$810.75 |
| Rate for Payer: Adventist Health Commercial |
$216.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$696.16
|
| Rate for Payer: Cash Price |
$486.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$731.84
|
| Rate for Payer: Heritage Provider Network Senior |
$731.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.25
|
| Rate for Payer: Multiplan Commercial |
$810.75
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.80 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$778.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$503.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$595.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$778.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$778.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$778.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$567.00
|
| Rate for Payer: Heritage Provider Network Senior |
$567.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$436.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$641.20
|
| Rate for Payer: Multiplan Commercial |
$687.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$778.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$778.60
|
| Rate for Payer: Vantage Medical Group Senior |
$778.60
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$165.80 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$589.90
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.13
|
| Rate for Payer: Heritage Provider Network Senior |
$620.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.00
|
| Rate for Payer: Multiplan Commercial |
$687.00
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.80 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$566.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$778.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$503.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$435.10
|
| Rate for Payer: Blue Shield of California EPN |
$346.25
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$595.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$778.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$778.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$778.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.13
|
| Rate for Payer: Heritage Provider Network Senior |
$620.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$436.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$641.20
|
| Rate for Payer: Multiplan Commercial |
$687.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$549.60
|
| Rate for Payer: TriValley Medical Group Senior |
$549.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$778.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$778.60
|
| Rate for Payer: Vantage Medical Group Senior |
$778.60
|
|
|
HC ARTERIAL LINE PERFORM/ASSIST
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 36620
|
| Hospital Charge Code |
901200092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.80 |
| Max. Negotiated Rate |
$687.00 |
| Rate for Payer: Adventist Health Commercial |
$183.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$589.90
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.13
|
| Rate for Payer: Heritage Provider Network Senior |
$620.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.00
|
| Rate for Payer: Multiplan Commercial |
$687.00
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
OP
|
$6,064.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$10,735.29 |
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,747.55
|
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,422.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2,647.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.75
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,941.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,577.76
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,753.62
|
| Rate for Payer: Heritage Provider Network Senior |
$3,753.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,892.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,156.86
|
| Rate for Payer: TriValley Medical Group Senior |
$7,156.86
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,338.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,338.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC ARTERIOGRAM PELVIS
|
Facility
|
IP
|
$6,064.00
|
|
|
Service Code
|
CPT 75736
|
| Hospital Charge Code |
909081625
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,097.58 |
| Max. Negotiated Rate |
$4,548.00 |
| Rate for Payer: Adventist Health Commercial |
$1,212.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,905.22
|
| Rate for Payer: Cash Price |
$2,728.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,105.33
|
| Rate for Payer: Heritage Provider Network Senior |
$4,105.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,097.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.00
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$391.01
|
| Rate for Payer: Blue Shield of California EPN |
$312.81
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$416.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$396.78
|
| Rate for Payer: Heritage Provider Network Senior |
$396.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$305.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$394.79
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$320.50
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$320.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$396.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$304.48
|
| Rate for Payer: Blue Shield of California EPN |
$242.30
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$416.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.96
|
| Rate for Payer: Heritage Provider Network Senior |
$433.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$305.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$384.60
|
| Rate for Payer: TriValley Medical Group Senior |
$384.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.80
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.96
|
| Rate for Payer: Heritage Provider Network Senior |
$433.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
|
|
HC ARTHO ASP &/OR INJ INTER JOINT
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
900501054
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.02 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$412.80
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$433.96
|
| Rate for Payer: Heritage Provider Network Senior |
$433.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.25
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$376.10
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.37
|
| Rate for Payer: Heritage Provider Network Senior |
$395.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$361.50
|
| Rate for Payer: Heritage Provider Network Senior |
$485.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$750.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$434.27
|
| Rate for Payer: TriValley Medical Group Senior |
$434.27
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,093.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
IP
|
$584.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$376.10
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.37
|
| Rate for Payer: Heritage Provider Network Senior |
$395.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
|
|
HC ARTHO ASP &/OR INJ SM JOINT
|
Facility
|
OP
|
$584.00
|
|
|
Service Code
|
CPT 20600
|
| Hospital Charge Code |
909000109
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$116.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$360.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$277.40
|
| Rate for Payer: Blue Shield of California EPN |
$220.75
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$379.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$394.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$395.37
|
| Rate for Payer: Heritage Provider Network Senior |
$395.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$278.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$438.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: TriValley Medical Group Commercial |
$350.40
|
| Rate for Payer: TriValley Medical Group Senior |
$350.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC ARTHRDSIS POST INTRBDY LMBR
|
Facility
|
IP
|
$77,449.00
|
|
|
Service Code
|
CPT 22630
|
| Hospital Charge Code |
900100963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,018.27 |
| Max. Negotiated Rate |
$58,086.75 |
| Rate for Payer: Adventist Health Commercial |
$15,489.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$49,877.16
|
| Rate for Payer: Cash Price |
$34,852.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$52,432.97
|
| Rate for Payer: Heritage Provider Network Senior |
$52,432.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,018.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,362.25
|
| Rate for Payer: Multiplan Commercial |
$58,086.75
|
|
|
HC ARTHRDSIS POST INTRBDY LMBR
|
Facility
|
OP
|
$77,449.00
|
|
|
Service Code
|
CPT 22630
|
| Hospital Charge Code |
900100963
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$66,307.89 |
| Rate for Payer: Adventist Health Commercial |
$15,489.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$47,863.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52,348.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38,388.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34,898.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,108.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$34,852.05
|
| Rate for Payer: Cash Price |
$34,852.05
|
| Rate for Payer: Cash Price |
$34,852.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$50,341.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52,348.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$38,388.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34,898.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$34,898.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$47,940.93
|
| Rate for Payer: Heritage Provider Network Senior |
$42,925.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34,898.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$66,307.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,018.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40,133.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19,362.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46,764.51
|
| Rate for Payer: Multiplan Commercial |
$58,086.75
|
| Rate for Payer: Multiplan WC |
$37,230.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$38,388.78
|
| Rate for Payer: TriValley Medical Group Senior |
$38,388.78
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52,348.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38,388.78
|
| Rate for Payer: Vantage Medical Group Senior |
$34,898.89
|
|
|
HC ARTHRITIS SERIES
|
Facility
|
OP
|
$2,038.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,259.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.97
|
| Rate for Payer: Blue Shield of California Commercial |
$411.50
|
| Rate for Payer: Blue Shield of California EPN |
$330.92
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,324.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,202.42
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,261.52
|
| Rate for Payer: Heritage Provider Network Senior |
$1,261.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$972.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$120.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$120.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ARTHRITIS SERIES
|
Facility
|
IP
|
$2,038.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
909001604
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.88 |
| Max. Negotiated Rate |
$1,528.50 |
| Rate for Payer: Adventist Health Commercial |
$407.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,312.47
|
| Rate for Payer: Cash Price |
$917.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,379.73
|
| Rate for Payer: Heritage Provider Network Senior |
$1,379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$368.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.50
|
| Rate for Payer: Multiplan Commercial |
$1,528.50
|
|
|
HC ARTHRODESIS, POST/POST TECH SNGL IS; LUMBAR
|
Facility
|
OP
|
$54,066.00
|
|
|
Service Code
|
CPT 22612
|
| Hospital Charge Code |
909000612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,674.01 |
| Max. Negotiated Rate |
$42,847.70 |
| Rate for Payer: Adventist Health Commercial |
$10,813.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,412.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,829.24
|
| Rate for Payer: Blue Shield of California EPN |
$8,674.01
|
| Rate for Payer: Cash Price |
$24,329.70
|
| Rate for Payer: Cash Price |
$24,329.70
|
| Rate for Payer: Cash Price |
$24,329.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,142.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,551.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,466.85
|
| Rate for Payer: Heritage Provider Network Senior |
$27,738.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42,847.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,785.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,934.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,516.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: Multiplan Commercial |
$40,549.50
|
| Rate for Payer: Multiplan WC |
$37,230.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,806.56
|
| Rate for Payer: TriValley Medical Group Senior |
$24,806.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$14,160.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,956.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
|
HC ARTHRODESIS, POST/POST TECH SNGL IS; LUMBAR
|
Facility
|
IP
|
$54,066.00
|
|
|
Service Code
|
CPT 22612
|
| Hospital Charge Code |
909000612
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,785.95 |
| Max. Negotiated Rate |
$40,549.50 |
| Rate for Payer: Adventist Health Commercial |
$10,813.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,818.50
|
| Rate for Payer: Cash Price |
$24,329.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,602.68
|
| Rate for Payer: Heritage Provider Network Senior |
$36,602.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,785.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,516.50
|
| Rate for Payer: Multiplan Commercial |
$40,549.50
|
|
|
HC ARTHRODESIS SACROILIAC JOINT
|
Facility
|
OP
|
$53,924.00
|
|
|
Service Code
|
CPT 27279
|
| Hospital Charge Code |
909027279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,178.49 |
| Max. Negotiated Rate |
$42,847.70 |
| Rate for Payer: Adventist Health Commercial |
$10,784.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$33,325.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,551.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$24,265.80
|
| Rate for Payer: Cash Price |
$24,265.80
|
| Rate for Payer: Cash Price |
$24,265.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35,050.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$24,806.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,551.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$22,551.42
|
| Rate for Payer: Heritage Provider Network Commercial |
$33,378.96
|
| Rate for Payer: Heritage Provider Network Senior |
$27,738.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,551.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$42,847.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,760.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25,934.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,481.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30,218.90
|
| Rate for Payer: Multiplan Commercial |
$40,443.00
|
| Rate for Payer: Multiplan WC |
$37,230.18
|
| Rate for Payer: TriValley Medical Group Commercial |
$24,806.56
|
| Rate for Payer: TriValley Medical Group Senior |
$24,806.56
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$17,861.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15,025.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33,827.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24,806.56
|
| Rate for Payer: Vantage Medical Group Senior |
$22,551.42
|
|
