|
HC RENAL CYST ASPIRATION
|
Facility
|
IP
|
$3,842.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$922.08 |
| Max. Negotiated Rate |
$3,265.70 |
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.80
|
| Rate for Payer: Galaxy Health WC |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.08
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
|
|
HC RENAL CYST ASPIRATION
|
Facility
|
OP
|
$3,842.00
|
|
|
Service Code
|
CPT 50390
|
| Hospital Charge Code |
909000164
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$134.41 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,305.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cash Price |
$1,728.90
|
| Rate for Payer: Cigna of CA PPO |
$2,843.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$3,265.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,305.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,881.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,562.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$922.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$3,073.60
|
| Rate for Payer: Networks By Design Commercial |
$2,497.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,265.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,305.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
OP
|
$1,503.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$1,464.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,464.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.90
|
| Rate for Payer: Blue Distinction Transplant |
$901.80
|
| Rate for Payer: Blue Shield of California Commercial |
$888.27
|
| Rate for Payer: Blue Shield of California EPN |
$704.91
|
| Rate for Payer: Cash Price |
$676.35
|
| Rate for Payer: Cash Price |
$676.35
|
| Rate for Payer: Cigna of CA HMO |
$961.92
|
| Rate for Payer: Cigna of CA PPO |
$1,112.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Dignity Health Media |
$689.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$758.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,277.55
|
| Rate for Payer: Global Benefits Group Commercial |
$901.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,127.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,130.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,130.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,116.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$689.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$868.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$1,202.40
|
| Rate for Payer: Networks By Design Commercial |
$976.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,277.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$901.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$901.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC RENAL CYST PUNCTURE
|
Facility
|
IP
|
$1,503.00
|
|
|
Service Code
|
CPT 74470
|
| Hospital Charge Code |
909001941
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$360.72 |
| Max. Negotiated Rate |
$1,277.55 |
| Rate for Payer: Cash Price |
$676.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$601.20
|
| Rate for Payer: Galaxy Health WC |
$1,277.55
|
| Rate for Payer: Global Benefits Group Commercial |
$901.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,002.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$572.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$360.72
|
| Rate for Payer: Multiplan Commercial |
$1,202.40
|
| Rate for Payer: Networks By Design Commercial |
$976.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,277.55
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
OP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$600.91 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,184.60
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: Cigna of CA PPO |
$6,394.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,480.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,763.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$600.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,073.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$6,912.80
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,184.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
IP
|
$8,641.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,073.84 |
| Max. Negotiated Rate |
$7,344.85 |
| Rate for Payer: Cash Price |
$3,888.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,456.40
|
| Rate for Payer: Galaxy Health WC |
$7,344.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,184.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,763.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,292.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,073.84
|
| Rate for Payer: Multiplan Commercial |
$6,912.80
|
| Rate for Payer: Networks By Design Commercial |
$5,616.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,344.85
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
OP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$432.65 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: Cigna of CA PPO |
$6,715.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,806.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,053.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,445.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
IP
|
$9,075.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,178.00 |
| Max. Negotiated Rate |
$7,713.75 |
| Rate for Payer: Cash Price |
$4,083.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,630.00
|
| Rate for Payer: Galaxy Health WC |
$7,713.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,053.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,457.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,178.00
|
| Rate for Payer: Multiplan Commercial |
$7,260.00
|
| Rate for Payer: Networks By Design Commercial |
$5,898.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,713.75
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
IP
|
$4,095.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$982.80 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Cash Price |
$1,842.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,638.00
|
| Rate for Payer: Galaxy Health WC |
$3,480.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,731.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,560.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.80
|
| Rate for Payer: Multiplan Commercial |
$3,276.00
|
| Rate for Payer: Networks By Design Commercial |
$2,661.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,480.75
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
OP
|
$4,095.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$366.60 |
| Max. Negotiated Rate |
$3,480.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,213.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,439.80
|
| Rate for Payer: Blue Distinction Transplant |
$2,457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,420.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,920.56
|
| Rate for Payer: Cash Price |
$1,842.75
|
| Rate for Payer: Cash Price |
$1,842.75
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$3,030.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$3,480.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,457.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,071.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,731.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$3,276.00
|
| Rate for Payer: Networks By Design Commercial |
$2,661.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,480.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,457.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,457.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$16,097.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,658.20
|
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Cigna of CA PPO |
$11,911.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$13,682.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,658.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,072.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,736.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,863.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$12,877.60
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$10,463.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,682.45
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,658.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,048.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,048.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,048.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,048.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$16,097.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,863.28 |
| Max. Negotiated Rate |
$13,682.45 |
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,438.80
|
| Rate for Payer: Galaxy Health WC |
$13,682.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,658.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,736.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,132.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,863.28
|
| Rate for Payer: Multiplan Commercial |
$12,877.60
|
| Rate for Payer: Networks By Design Commercial |
$10,463.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,682.45
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,358.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA PPO |
$2,908.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,947.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,287.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$943.20 |
| Max. Negotiated Rate |
$3,340.50 |
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Galaxy Health WC |
$3,340.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,358.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,621.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$943.20
|
| Rate for Payer: Multiplan Commercial |
$3,144.00
|
| Rate for Payer: Networks By Design Commercial |
$2,554.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,340.50
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cigna of CA PPO |
$1,861.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,886.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,509.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.60 |
| Max. Negotiated Rate |
$2,137.75 |
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.00
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.60
|
| Rate for Payer: Multiplan Commercial |
$2,012.00
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
IP
|
$7,451.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,788.24 |
| Max. Negotiated Rate |
$6,333.35 |
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,980.40
|
| Rate for Payer: Galaxy Health WC |
$6,333.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,969.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,838.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,788.24
|
| Rate for Payer: Multiplan Commercial |
$5,960.80
|
| Rate for Payer: Networks By Design Commercial |
$4,843.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,333.35
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
OP
|
$7,451.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,649.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,470.60
|
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: Cash Price |
$3,352.95
|
| Rate for Payer: Cigna of CA PPO |
$5,513.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$6,333.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,588.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,649.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$13,649.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,969.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,788.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$5,960.80
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: Networks By Design Commercial |
$4,843.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,333.35
|
| Rate for Payer: Prime Health Services WC |
$11,262.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,725.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,725.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,725.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,725.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
IP
|
$6,356.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,525.44 |
| Max. Negotiated Rate |
$5,402.60 |
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,542.40
|
| Rate for Payer: Galaxy Health WC |
$5,402.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,421.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.44
|
| Rate for Payer: Multiplan Commercial |
$5,084.80
|
| Rate for Payer: Networks By Design Commercial |
$4,131.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,402.60
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
OP
|
$6,356.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,813.60
|
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Cigna of CA PPO |
$4,703.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,402.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,767.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$5,084.80
|
| Rate for Payer: Networks By Design Commercial |
$4,131.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,402.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,813.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,178.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,178.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,178.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
OP
|
$9,650.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$715.16 |
| Max. Negotiated Rate |
$8,202.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,790.00
|
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Cigna of CA PPO |
$7,141.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$8,202.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,790.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,237.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,436.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,316.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$7,720.00
|
| Rate for Payer: Networks By Design Commercial |
$6,272.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,202.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,790.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,825.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,825.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,825.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,825.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
IP
|
$9,650.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,316.00 |
| Max. Negotiated Rate |
$8,202.50 |
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,860.00
|
| Rate for Payer: Galaxy Health WC |
$8,202.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,790.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,436.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,676.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,316.00
|
| Rate for Payer: Multiplan Commercial |
$7,720.00
|
| Rate for Payer: Networks By Design Commercial |
$6,272.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,202.50
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
IP
|
$10,489.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,517.36 |
| Max. Negotiated Rate |
$8,915.65 |
| Rate for Payer: Cash Price |
$4,720.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,195.60
|
| Rate for Payer: Galaxy Health WC |
$8,915.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,293.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,996.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,996.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,517.36
|
| Rate for Payer: Multiplan Commercial |
$8,391.20
|
| Rate for Payer: Networks By Design Commercial |
$6,817.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,915.65
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
OP
|
$10,489.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$823.38 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,293.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.39
|
| Rate for Payer: Blue Shield of California EPN |
$6,125.58
|
| Rate for Payer: Cash Price |
$4,720.05
|
| Rate for Payer: Cash Price |
$4,720.05
|
| Rate for Payer: Cigna of CA PPO |
$7,761.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$8,915.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,293.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,866.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,551.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,996.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,517.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$8,391.20
|
| Rate for Payer: Networks By Design Commercial |
$6,817.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,915.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,293.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,293.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FOOT TENDON
|
Facility
|
OP
|
$8,408.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,044.80
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cigna of CA PPO |
$6,221.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$7,146.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,044.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,306.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,017.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$6,726.40
|
| Rate for Payer: Networks By Design Commercial |
$5,465.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,146.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,044.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
