|
HC REPAIR FOOT TENDON
|
Facility
|
IP
|
$8,408.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,017.92 |
| Max. Negotiated Rate |
$7,146.80 |
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,363.20
|
| Rate for Payer: Galaxy Health WC |
$7,146.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,044.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,203.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,017.92
|
| 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
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
IP
|
$7,945.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,906.80 |
| Max. Negotiated Rate |
$6,753.25 |
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,178.00
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,027.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.80
|
| Rate for Payer: Multiplan Commercial |
$6,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
OP
|
$7,945.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$12,491.00 |
| 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 |
$4,767.00
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cigna of CA PPO |
$5,879.30
|
| 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 |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,958.75
|
| 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 |
$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 |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.80
|
| 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 |
$6,356.00
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,767.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,972.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,972.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.50
|
| 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 INTL INGUINAL HERNIA
|
Facility
|
OP
|
$10,920.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.01 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,552.00
|
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Cigna of CA PPO |
$8,080.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$9,282.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,552.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,190.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,089.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,089.10
|
| 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 |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,283.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,620.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$8,736.00
|
| Rate for Payer: Networks By Design Commercial |
$7,098.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,282.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,552.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,460.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
IP
|
$10,920.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,620.80 |
| Max. Negotiated Rate |
$9,282.00 |
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,368.00
|
| Rate for Payer: Galaxy Health WC |
$9,282.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,552.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,283.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,160.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,620.80
|
| Rate for Payer: Multiplan Commercial |
$8,736.00
|
| Rate for Payer: Networks By Design Commercial |
$7,098.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,282.00
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
OP
|
$11,148.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,688.80
|
| Rate for Payer: Cash Price |
$5,016.60
|
| Rate for Payer: Cash Price |
$5,016.60
|
| Rate for Payer: Cash Price |
$5,016.60
|
| Rate for Payer: Cigna of CA PPO |
$8,249.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Media |
$6,530.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,815.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,530.21
|
| Rate for Payer: Galaxy Health WC |
$9,475.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,688.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,361.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,709.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$10,709.54
|
| 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 |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,435.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,609.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,530.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,675.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.48
|
| Rate for Payer: Multiplan Commercial |
$8,918.40
|
| Rate for Payer: Networks By Design Commercial |
$7,246.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,475.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,688.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,574.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,574.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,574.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
IP
|
$11,148.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,675.52 |
| Max. Negotiated Rate |
$9,475.80 |
| Rate for Payer: Cash Price |
$5,016.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,459.20
|
| Rate for Payer: Galaxy Health WC |
$9,475.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,688.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,435.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,247.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,675.52
|
| Rate for Payer: Multiplan Commercial |
$8,918.40
|
| Rate for Payer: Networks By Design Commercial |
$7,246.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,475.80
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
IP
|
$4,751.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,140.24 |
| Max. Negotiated Rate |
$4,038.35 |
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.40
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.24
|
| Rate for Payer: Multiplan Commercial |
$3,800.80
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
OP
|
$4,751.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.76 |
| 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 |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.60
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cigna of CA PPO |
$3,515.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,563.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| 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 |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,140.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$3,800.80
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,375.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,375.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,375.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,375.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
OP
|
$4,999.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| 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 |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,999.40
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cigna of CA PPO |
$3,699.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,749.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| 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 |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$3,999.20
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,999.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
IP
|
$4,999.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,199.76 |
| Max. Negotiated Rate |
$4,249.15 |
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.60
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,904.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,199.76
|
| Rate for Payer: Multiplan Commercial |
$3,999.20
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.15 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$458.40
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| 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 |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$611.20
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.00
|
| Rate for Payer: United Healthcare All Other HMO |
$382.00
|
| Rate for Payer: United Healthcare HMO Rider |
$382.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$382.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.36 |
| Max. Negotiated Rate |
$649.40 |
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.36
|
| Rate for Payer: Multiplan Commercial |
$611.20
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
IP
|
$5,579.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,338.96 |
| Max. Negotiated Rate |
$4,742.15 |
| Rate for Payer: Cash Price |
$2,510.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,231.60
|
| Rate for Payer: Galaxy Health WC |
$4,742.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,347.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,721.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,125.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.96
|
| Rate for Payer: Multiplan Commercial |
$4,463.20
|
| Rate for Payer: Networks By Design Commercial |
$3,626.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,742.15
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
OP
|
$5,579.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| 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 |
$3,347.40
|
| Rate for Payer: Cash Price |
$2,510.55
|
| Rate for Payer: Cash Price |
$2,510.55
|
| Rate for Payer: Cash Price |
$2,510.55
|
| Rate for Payer: Cigna of CA PPO |
$4,128.46
|
| 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 |
$4,742.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,347.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,184.25
|
| 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 |
$3,721.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.96
|
| 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 |
$4,463.20
|
| Rate for Payer: Networks By Design Commercial |
$3,626.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,742.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,347.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,789.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,789.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,789.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,789.50
|
| 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 OF CORNEAL LACERATION
|
Facility
|
IP
|
$5,871.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,409.04 |
| Max. Negotiated Rate |
$4,990.35 |
| Rate for Payer: Cash Price |
$2,641.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,348.40
|
| Rate for Payer: Galaxy Health WC |
$4,990.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,522.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,915.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,236.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,409.04
|
| Rate for Payer: Multiplan Commercial |
$4,696.80
|
| Rate for Payer: Networks By Design Commercial |
$3,816.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,990.35
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
OP
|
$5,871.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.50 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,522.60
|
| Rate for Payer: Cash Price |
$2,641.95
|
| Rate for Payer: Cash Price |
$2,641.95
|
| Rate for Payer: Cash Price |
$2,641.95
|
| Rate for Payer: Cigna of CA PPO |
$4,344.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Media |
$6,530.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,815.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,530.21
|
| Rate for Payer: Galaxy Health WC |
$4,990.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,522.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,403.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,709.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$10,709.54
|
| 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 |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,915.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,530.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,409.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.48
|
| Rate for Payer: Multiplan Commercial |
$4,696.80
|
| Rate for Payer: Networks By Design Commercial |
$3,816.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,990.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,935.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,935.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,935.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,935.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$5,345.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| 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 |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,207.00
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cigna of CA PPO |
$3,955.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,008.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| 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 |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,565.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,672.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,672.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,672.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,672.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,282.80 |
| Max. Negotiated Rate |
$4,543.25 |
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.00
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,565.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,036.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
IP
|
$3,345.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$802.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.00
|
| Rate for Payer: Galaxy Health WC |
$2,843.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,007.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,231.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,274.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.80
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,843.25
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
OP
|
$3,345.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$14,530.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,530.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,843.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,839.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,007.00
|
| 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 |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Cigna of CA PPO |
$2,475.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,843.25
|
| Rate for Payer: Dignity Health Media |
$2,843.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,843.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,338.00
|
| Rate for Payer: Galaxy Health WC |
$2,843.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,007.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,508.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,231.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$802.80
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,174.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,843.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,007.00
|
| 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 |
$2,843.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,843.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,843.25
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$9,045.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,427.00
|
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Cigna of CA PPO |
$6,693.30
|
| 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 |
$7,688.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,427.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,783.75
|
| 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 |
$6,033.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,170.80
|
| 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 |
$7,236.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$5,879.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,688.25
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,427.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,522.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,522.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,522.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,522.50
|
| 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 OF THIGH MUSCLE
|
Facility
|
IP
|
$9,045.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,170.80 |
| Max. Negotiated Rate |
$7,688.25 |
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,618.00
|
| Rate for Payer: Galaxy Health WC |
$7,688.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,427.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,033.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,446.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,170.80
|
| Rate for Payer: Multiplan Commercial |
$7,236.00
|
| Rate for Payer: Networks By Design Commercial |
$5,879.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,688.25
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$14,235.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.33 |
| Max. Negotiated Rate |
$12,099.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,541.00
|
| Rate for Payer: Cash Price |
$6,405.75
|
| Rate for Payer: Cash Price |
$6,405.75
|
| Rate for Payer: Cash Price |
$6,405.75
|
| Rate for Payer: Cigna of CA PPO |
$10,533.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Galaxy Health WC |
$12,099.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,541.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,676.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| 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 |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,494.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,416.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan Commercial |
$11,388.00
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Networks By Design Commercial |
$9,252.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,099.75
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,541.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,117.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,117.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,117.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$14,235.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,416.40 |
| Max. Negotiated Rate |
$12,099.75 |
| Rate for Payer: Cash Price |
$6,405.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,694.00
|
| Rate for Payer: Galaxy Health WC |
$12,099.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,541.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,494.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,423.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,416.40
|
| Rate for Payer: Multiplan Commercial |
$11,388.00
|
| Rate for Payer: Networks By Design Commercial |
$9,252.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,099.75
|
|
