|
HC ARTHRODESIS SACROILIAC JOINT
|
Facility
|
IP
|
$53,924.00
|
|
|
Service Code
|
CPT 27279
|
| Hospital Charge Code |
909027279
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,760.24 |
| Max. Negotiated Rate |
$40,443.00 |
| Rate for Payer: Adventist Health Commercial |
$10,784.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$34,727.06
|
| Rate for Payer: Cash Price |
$24,265.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$36,506.55
|
| Rate for Payer: Heritage Provider Network Senior |
$36,506.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,760.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13,481.00
|
| Rate for Payer: Multiplan Commercial |
$40,443.00
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$209.06 |
| Max. Negotiated Rate |
$866.25 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$743.82
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$781.93
|
| Rate for Payer: Heritage Provider Network Senior |
$781.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.75
|
| Rate for Payer: Multiplan Commercial |
$866.25
|
|
|
HC ARTHROGRAPH ANKLE
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 73615
|
| Hospital Charge Code |
909001663
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$209.06 |
| Max. Negotiated Rate |
$866.25 |
| Rate for Payer: Adventist Health Commercial |
$231.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$713.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.07
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$750.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$681.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$714.95
|
| Rate for Payer: Heritage Provider Network Senior |
$714.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$550.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$866.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$131.77 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Adventist Health Commercial |
$145.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$468.83
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$492.86
|
| Rate for Payer: Heritage Provider Network Senior |
$492.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.00
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
|
|
HC ARTHROGRAPH ELBOW
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
909001481
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$131.77 |
| Max. Negotiated Rate |
$673.07 |
| Rate for Payer: Adventist Health Commercial |
$145.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$449.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.07
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$473.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.63
|
| Rate for Payer: Heritage Provider Network Senior |
$450.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$347.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$131.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$546.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
IP
|
$1,301.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$837.84
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.78
|
| Rate for Payer: Heritage Provider Network Senior |
$880.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
|
|
HC ARTHROGRAPH HIP
|
Facility
|
OP
|
$1,301.00
|
|
|
Service Code
|
CPT 73525
|
| Hospital Charge Code |
909001659
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$975.75 |
| Rate for Payer: Adventist Health Commercial |
$260.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$804.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.07
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Cash Price |
$585.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$845.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$767.59
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$805.32
|
| Rate for Payer: Heritage Provider Network Senior |
$805.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$620.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$235.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$975.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
OP
|
$1,757.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,085.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$711.84
|
| Rate for Payer: Blue Shield of California Commercial |
$549.46
|
| Rate for Payer: Blue Shield of California EPN |
$441.85
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,142.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,036.63
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,087.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,087.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$838.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC ARTHROGRAPH KNEE
|
Facility
|
IP
|
$1,757.00
|
|
|
Service Code
|
CPT 73580
|
| Hospital Charge Code |
909001658
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$318.02 |
| Max. Negotiated Rate |
$1,317.75 |
| Rate for Payer: Adventist Health Commercial |
$351.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,131.51
|
| Rate for Payer: Cash Price |
$790.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,189.49
|
| Rate for Payer: Heritage Provider Network Senior |
$1,189.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$439.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.75
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$568.07
|
| Rate for Payer: Blue Shield of California Commercial |
$441.55
|
| Rate for Payer: Blue Shield of California EPN |
$355.08
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$863.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.52
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$822.03
|
| Rate for Payer: Heritage Provider Network Senior |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$633.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC ARTHROGRAPH SHOULDER
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
CPT 73040
|
| Hospital Charge Code |
909001480
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Adventist Health Commercial |
$265.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$855.23
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$899.06
|
| Rate for Payer: Heritage Provider Network Senior |
$899.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$240.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.00
|
| Rate for Payer: Multiplan Commercial |
$996.00
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
OP
|
$1,578.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$268.27 |
| Max. Negotiated Rate |
$1,183.50 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.62
|
| Rate for Payer: Blue Shield of California Commercial |
$333.60
|
| Rate for Payer: Blue Shield of California EPN |
$268.27
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,025.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$931.02
|
| Rate for Payer: EPIC Health Plan Medicare |
$448.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$976.78
|
| Rate for Payer: Heritage Provider Network Senior |
$976.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$752.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$448.71
|
| Rate for Payer: TriValley Medical Group Senior |
$448.71
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$448.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$448.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC ARTHROGRAPH WRIST
|
Facility
|
IP
|
$1,578.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
909001482
|
|
Hospital Revenue Code
|
322
|
| Min. Negotiated Rate |
$285.62 |
| Max. Negotiated Rate |
$1,183.50 |
| Rate for Payer: Adventist Health Commercial |
$315.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,016.23
|
| Rate for Payer: Cash Price |
$710.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,068.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,068.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$285.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$394.50
|
| Rate for Payer: Multiplan Commercial |
$1,183.50
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
|
IP
|
$8,084.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,463.20 |
| Max. Negotiated Rate |
$6,063.00 |
| Rate for Payer: Adventist Health Commercial |
$1,616.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,206.10
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,472.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,472.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,463.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Multiplan Commercial |
$6,063.00
|
|
|
HC ARTHROTOMY ANKLE
|
Facility
|
OP
|
$8,084.00
|
|
|
Service Code
|
CPT 27610
|
| Hospital Charge Code |
900501781
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,463.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,616.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,995.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,839.90
|
| Rate for Payer: Blue Shield of California EPN |
$3,055.75
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cash Price |
$3,637.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,254.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,472.87
|
| Rate for Payer: Heritage Provider Network Senior |
$5,472.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,856.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,463.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,021.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,063.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,850.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,850.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC ASPARAGUS IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.95 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$42.50
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.68
|
| Rate for Payer: Heritage Provider Network Senior |
$44.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
|
|
HC ASPARAGUS IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913632
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$150.09 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$40.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.09
|
| Rate for Payer: Blue Shield of California Commercial |
$42.05
|
| Rate for Payer: Blue Shield of California EPN |
$33.73
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$42.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Medicare |
$5.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Heritage Provider Network Senior |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$31.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$5.22
|
| Rate for Payer: TriValley Medical Group Senior |
$5.22
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
IP
|
$1,937.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.60 |
| Max. Negotiated Rate |
$1,452.75 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,247.43
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,311.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,311.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$350.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.25
|
| Rate for Payer: Multiplan Commercial |
$1,452.75
|
|
|
HC ASPIRATION/BLADDER BY NEEDLE
|
Facility
|
OP
|
$1,937.00
|
|
|
Service Code
|
CPT 51100
|
| Hospital Charge Code |
900501596
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$387.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,197.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$920.08
|
| Rate for Payer: Blue Shield of California EPN |
$732.19
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Cash Price |
$871.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,259.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$321.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,311.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,311.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$923.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$350.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$484.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,452.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,162.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,162.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$545.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$573.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$907.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$545.96
|
| Rate for Payer: Heritage Provider Network Senior |
$1,116.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,724.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,044.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$661.50
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$998.67
|
| Rate for Payer: TriValley Medical Group Senior |
$998.67
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
|
HC ASPIRATION INJECTION INTERM JONT W US GUID
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 20606
|
| Hospital Charge Code |
906620606
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.64 |
| Max. Negotiated Rate |
$661.50 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$568.01
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$597.11
|
| Rate for Payer: Heritage Provider Network Senior |
$597.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.50
|
| Rate for Payer: Multiplan Commercial |
$661.50
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$728.25 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.32
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$657.37
|
| Rate for Payer: Heritage Provider Network Senior |
$657.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
|
|
HC ASPIRATION INJECTION MAJOR JONT W US GUID
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 20611
|
| Hospital Charge Code |
906620611
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$194.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$600.08
|
| 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 |
$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 |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$631.15
|
| 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 |
$601.05
|
| 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 |
$175.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$728.25
|
| 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 ASPIRATION INJECTION SM JONT W US GUID
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Adventist Health Commercial |
$168.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$540.96
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.68
|
| Rate for Payer: Heritage Provider Network Senior |
$568.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$152.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
|
|
HC ASPIRATION INJECTION SM JONT W US GUID
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 20604
|
| Hospital Charge Code |
906620604
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$168.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$519.12
|
| 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 |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$546.00
|
| 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 |
$519.96
|
| 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 |
$152.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$454.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| 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
|
|
