|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
OP
|
$8,010.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,602.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cigna of CA HMO |
$5,126.40
|
| Rate for Payer: Cigna of CA PPO |
$5,927.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,607.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,086.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,408.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,806.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,005.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,005.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,005.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,005.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$6,808.50 |
| Rate for Payer: Adventist Health Commercial |
$1,602.00
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,607.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,204.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,204.00
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,086.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,725.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.40
|
| Rate for Payer: Multiplan Commercial |
$6,408.00
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
OP
|
$8,010.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$3,284.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,047.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Cigna of CA HMO |
$5,126.40
|
| Rate for Payer: Cigna of CA PPO |
$5,927.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,607.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,086.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$6,408.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,806.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,806.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC TREATMENT OF SPEECH, GROUP
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
908600396
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$396.10 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$326.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.40
|
| Rate for Payer: EPIC Health Plan Senior |
$186.40
|
| Rate for Payer: Galaxy Health WC |
$396.10
|
| Rate for Payer: Global Benefits Group Commercial |
$279.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$295.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: Networks By Design Commercial |
$302.90
|
| Rate for Payer: Prime Health Services Commercial |
$396.10
|
|
|
HC TREATMENT OF SPEECH, GROUP
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
908600396
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$111.84 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$191.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$305.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$349.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cigna of CA HMO |
$298.24
|
| Rate for Payer: Cigna of CA PPO |
$344.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$396.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$396.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$326.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.40
|
| Rate for Payer: EPIC Health Plan Senior |
$186.40
|
| Rate for Payer: Galaxy Health WC |
$396.10
|
| Rate for Payer: Global Benefits Group Commercial |
$279.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$295.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$274.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$326.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$326.20
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: Networks By Design Commercial |
$302.90
|
| Rate for Payer: Prime Health Services Commercial |
$396.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$279.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$279.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$396.10
|
| Rate for Payer: Vantage Medical Group Senior |
$396.10
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.61
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.61
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$379.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.61
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$450.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$408.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$233.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
OP
|
$709.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Cigna of CA HMO |
$453.76
|
| Rate for Payer: Cigna of CA PPO |
$524.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$425.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$354.50
|
| Rate for Payer: United Healthcare All Other HMO |
$354.50
|
| Rate for Payer: United Healthcare HMO Rider |
$354.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$354.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
IP
|
$709.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.80 |
| Max. Negotiated Rate |
$602.65 |
| Rate for Payer: Adventist Health Commercial |
$141.80
|
| Rate for Payer: Cash Price |
$319.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$496.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$283.60
|
| Rate for Payer: EPIC Health Plan Senior |
$283.60
|
| Rate for Payer: Galaxy Health WC |
$602.65
|
| Rate for Payer: Global Benefits Group Commercial |
$425.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$450.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$418.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.16
|
| Rate for Payer: Multiplan Commercial |
$567.20
|
| Rate for Payer: Networks By Design Commercial |
$460.85
|
| Rate for Payer: Prime Health Services Commercial |
$602.65
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
OP
|
$1,759.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$351.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$791.55
|
| Rate for Payer: Cash Price |
$791.55
|
| Rate for Payer: Cash Price |
$791.55
|
| Rate for Payer: Cigna of CA HMO |
$1,125.76
|
| Rate for Payer: Cigna of CA PPO |
$1,301.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,231.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$1,495.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,055.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,116.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$528.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,143.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,495.15
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,055.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$879.50
|
| Rate for Payer: United Healthcare All Other HMO |
$879.50
|
| Rate for Payer: United Healthcare HMO Rider |
$879.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$879.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
IP
|
$1,759.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.80 |
| Max. Negotiated Rate |
$1,495.15 |
| Rate for Payer: Adventist Health Commercial |
$351.80
|
| Rate for Payer: Cash Price |
$791.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,231.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$703.60
|
| Rate for Payer: EPIC Health Plan Senior |
$703.60
|
| Rate for Payer: Galaxy Health WC |
$1,495.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,055.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,116.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,037.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.16
|
| Rate for Payer: Multiplan Commercial |
$1,407.20
|
| Rate for Payer: Networks By Design Commercial |
$1,143.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,495.15
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$881.45 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$414.80
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$658.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.88
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cigna of CA HMO |
$663.68
|
| Rate for Payer: Cigna of CA PPO |
$767.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$658.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.50
|
| Rate for Payer: United Healthcare All Other HMO |
$518.50
|
| Rate for Payer: United Healthcare HMO Rider |
$518.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$859.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cigna of CA HMO |
$663.68
|
| Rate for Payer: Cigna of CA PPO |
$767.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$658.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$622.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cigna of CA HMO |
$663.68
|
| Rate for Payer: Cigna of CA PPO |
$767.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$211.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$658.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$881.45 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$414.80
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$658.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.88
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$881.45 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$725.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$414.80
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$658.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$611.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.88
|
| Rate for Payer: Multiplan Commercial |
$829.60
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$1,161.95 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$546.80
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$868.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$806.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cigna of CA HMO |
$874.88
|
| Rate for Payer: Cigna of CA PPO |
$1,011.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$868.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$820.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.50
|
| Rate for Payer: United Healthcare All Other HMO |
$683.50
|
| Rate for Payer: United Healthcare HMO Rider |
$683.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT TOE DISLOCATION W/ ANES
|
Facility
|
OP
|
$6,891.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
902890358
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$5,857.35 |
| Rate for Payer: Adventist Health Commercial |
$2,825.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$859.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Cigna of CA HMO |
$4,410.24
|
| Rate for Payer: Cigna of CA PPO |
$5,099.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,823.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$5,857.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,134.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,375.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,653.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$453.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$5,512.80
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$4,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,857.35
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,134.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC TREAT TOE DISLOCATION W/ ANES
|
Facility
|
IP
|
$6,891.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
902890358
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,378.20 |
| Max. Negotiated Rate |
$5,857.35 |
| Rate for Payer: Adventist Health Commercial |
$1,378.20
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,823.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,756.40
|
| Rate for Payer: Galaxy Health WC |
$5,857.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,134.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,375.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,065.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,653.84
|
| Rate for Payer: Multiplan Commercial |
$5,512.80
|
| Rate for Payer: Networks By Design Commercial |
$4,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,857.35
|
|
