|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$437.76 |
| Max. Negotiated Rate |
$1,550.40 |
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.60
|
| Rate for Payer: Galaxy Health WC |
$1,550.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,094.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,216.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.76
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: Networks By Design Commercial |
$1,185.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,550.40
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| 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 |
$1,177.06
|
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,094.40
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cash Price |
$820.80
|
| Rate for Payer: Cigna of CA PPO |
$1,349.76
|
| 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 |
$1,550.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,094.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,368.00
|
| 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 |
$1,216.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.76
|
| 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 |
$1,459.20
|
| Rate for Payer: Networks By Design Commercial |
$1,185.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,550.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,094.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$912.00
|
| Rate for Payer: United Healthcare All Other HMO |
$912.00
|
| Rate for Payer: United Healthcare HMO Rider |
$912.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$912.00
|
| 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 REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
OP
|
$2,642.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$634.08 |
| 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 |
$1,177.06
|
| 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 |
$1,585.20
|
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Cigna of CA PPO |
$1,955.08
|
| 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 |
$2,245.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,981.50
|
| 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 |
$1,762.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.08
|
| 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 |
$2,113.60
|
| Rate for Payer: Networks By Design Commercial |
$1,717.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,245.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,321.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,321.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,321.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,321.00
|
| 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 REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
IP
|
$2,642.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$634.08 |
| Max. Negotiated Rate |
$2,245.70 |
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,056.80
|
| Rate for Payer: Galaxy Health WC |
$2,245.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,006.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$634.08
|
| Rate for Payer: Multiplan Commercial |
$2,113.60
|
| Rate for Payer: Networks By Design Commercial |
$1,717.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,245.70
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$468.00 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.31 |
| 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 |
$1,657.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,072.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,170.00
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cigna of CA PPO |
$1,443.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,657.50
|
| Rate for Payer: Dignity Health Media |
$1,657.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,657.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,462.50
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$975.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,657.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,657.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,657.50
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
OP
|
$1,673.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| 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 |
$1,422.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$920.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$920.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,003.80
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: Cigna of CA PPO |
$1,238.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,422.05
|
| Rate for Payer: Dignity Health Media |
$1,422.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,422.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.20
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,254.75
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$836.50
|
| Rate for Payer: United Healthcare All Other HMO |
$836.50
|
| Rate for Payer: United Healthcare HMO Rider |
$836.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$836.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,422.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,422.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,422.05
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
IP
|
$1,673.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$401.52 |
| Max. Negotiated Rate |
$1,422.05 |
| Rate for Payer: Cash Price |
$752.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.20
|
| Rate for Payer: Galaxy Health WC |
$1,422.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.52
|
| Rate for Payer: Multiplan Commercial |
$1,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,087.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.05
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.72 |
| Max. Negotiated Rate |
$1,702.55 |
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.20
|
| Rate for Payer: Galaxy Health WC |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.72
|
| Rate for Payer: Multiplan Commercial |
$1,602.40
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| 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 |
$1,702.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,101.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,101.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,201.80
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Cigna of CA PPO |
$1,482.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,702.55
|
| Rate for Payer: Dignity Health Media |
$1,702.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,702.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$801.20
|
| Rate for Payer: Galaxy Health WC |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,502.25
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$480.72
|
| Rate for Payer: Multiplan Commercial |
$1,602.40
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,201.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,001.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,001.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,001.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,001.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,702.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,702.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,702.55
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
OP
|
$8,091.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$567.30 |
| 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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,854.60
|
| Rate for Payer: Cash Price |
$3,640.95
|
| Rate for Payer: Cash Price |
$3,640.95
|
| Rate for Payer: Cash Price |
$3,640.95
|
| Rate for Payer: Cigna of CA PPO |
$5,987.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$6,877.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,854.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,068.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| 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 |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,396.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,941.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$6,472.80
|
| Rate for Payer: Networks By Design Commercial |
$5,259.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,877.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,854.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,045.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,045.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,045.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,045.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
IP
|
$8,091.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,941.84 |
| Max. Negotiated Rate |
$6,877.35 |
| Rate for Payer: Cash Price |
$3,640.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,236.40
|
| Rate for Payer: Galaxy Health WC |
$6,877.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,854.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,396.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,082.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,941.84
|
| Rate for Payer: Multiplan Commercial |
$6,472.80
|
| Rate for Payer: Networks By Design Commercial |
$5,259.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,877.35
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$10,198.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,447.52 |
| Max. Negotiated Rate |
$8,668.30 |
| Rate for Payer: Cash Price |
$4,589.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,079.20
|
| Rate for Payer: Galaxy Health WC |
$8,668.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,802.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,885.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,447.52
|
| Rate for Payer: Multiplan Commercial |
$8,158.40
|
| Rate for Payer: Networks By Design Commercial |
$6,628.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,668.30
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$10,198.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$556.70 |
| 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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,118.80
|
| Rate for Payer: Cash Price |
$4,589.10
|
| Rate for Payer: Cash Price |
$4,589.10
|
| Rate for Payer: Cash Price |
$4,589.10
|
| Rate for Payer: Cigna of CA PPO |
$7,546.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$8,668.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,118.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,648.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| 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 |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,802.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,447.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$8,158.40
|
| Rate for Payer: Networks By Design Commercial |
$6,628.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,668.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,099.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,099.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,099.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,099.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
IP
|
$2,060.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$494.40 |
| Max. Negotiated Rate |
$1,751.00 |
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$824.00
|
| Rate for Payer: Galaxy Health WC |
$1,751.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,236.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,374.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$784.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.40
|
| Rate for Payer: Multiplan Commercial |
$1,648.00
|
| Rate for Payer: Networks By Design Commercial |
$1,339.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,751.00
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
OP
|
$2,060.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.08 |
| 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 |
$1,751.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,133.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,133.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,236.00
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cash Price |
$927.00
|
| Rate for Payer: Cigna of CA PPO |
$1,524.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,751.00
|
| Rate for Payer: Dignity Health Media |
$1,751.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,751.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$824.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$824.00
|
| Rate for Payer: Galaxy Health WC |
$1,751.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,236.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,545.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,374.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$494.40
|
| Rate for Payer: Multiplan Commercial |
$1,648.00
|
| Rate for Payer: Networks By Design Commercial |
$1,339.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,751.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,236.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,030.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,030.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,030.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,030.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,751.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,751.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,751.00
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
OP
|
$12,995.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$25,512.00 |
| 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 |
$7,797.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,577.32
|
| Rate for Payer: Blue Shield of California EPN |
$7,589.08
|
| Rate for Payer: Cash Price |
$5,847.75
|
| Rate for Payer: Cash Price |
$5,847.75
|
| Rate for Payer: Cigna of CA PPO |
$9,616.30
|
| 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 |
$11,045.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,797.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,746.25
|
| 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 |
$13,483.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13,483.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,667.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,118.80
|
| 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 |
$10,396.00
|
| Rate for Payer: Networks By Design Commercial |
$8,446.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,045.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,797.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,797.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| 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 REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
IP
|
$12,995.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,118.80 |
| Max. Negotiated Rate |
$11,045.75 |
| Rate for Payer: Cash Price |
$5,847.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,198.00
|
| Rate for Payer: Galaxy Health WC |
$11,045.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,797.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,667.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,951.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,118.80
|
| Rate for Payer: Multiplan Commercial |
$10,396.00
|
| Rate for Payer: Networks By Design Commercial |
$8,446.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,045.75
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$8,196.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,967.04 |
| Max. Negotiated Rate |
$6,966.60 |
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,278.40
|
| Rate for Payer: Galaxy Health WC |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,466.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,122.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.04
|
| Rate for Payer: Multiplan Commercial |
$6,556.80
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
OP
|
$8,196.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.74 |
| 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 |
$4,917.60
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cash Price |
$3,688.20
|
| Rate for Payer: Cigna of CA PPO |
$6,065.04
|
| 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 |
$6,966.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,917.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,147.00
|
| 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 |
$5,466.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,967.04
|
| 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 |
$6,556.80
|
| Rate for Payer: Networks By Design Commercial |
$5,327.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,966.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,917.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,098.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,098.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,098.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,098.00
|
| 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 REP INT WNDS 7.6-12.5CM
|
Facility
|
OP
|
$1,879.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.14 |
| 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 |
$1,127.40
|
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: Cigna of CA PPO |
$1,390.46
|
| 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 |
$1,597.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,409.25
|
| 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 |
$1,253.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.96
|
| 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 |
$1,503.20
|
| Rate for Payer: Networks By Design Commercial |
$1,221.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,127.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$939.50
|
| Rate for Payer: United Healthcare All Other HMO |
$939.50
|
| Rate for Payer: United Healthcare HMO Rider |
$939.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$939.50
|
| 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 REP INT WNDS 7.6-12.5CM
|
Facility
|
IP
|
$1,879.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$450.96 |
| Max. Negotiated Rate |
$1,597.15 |
| Rate for Payer: Cash Price |
$845.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$751.60
|
| Rate for Payer: Galaxy Health WC |
$1,597.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,127.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,253.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$450.96
|
| Rate for Payer: Multiplan Commercial |
$1,503.20
|
| Rate for Payer: Networks By Design Commercial |
$1,221.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,597.15
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
IP
|
$2,746.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$659.04 |
| Max. Negotiated Rate |
$2,334.10 |
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,098.40
|
| Rate for Payer: Galaxy Health WC |
$2,334.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,831.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,046.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.04
|
| Rate for Payer: Multiplan Commercial |
$2,196.80
|
| Rate for Payer: Networks By Design Commercial |
$1,784.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.10
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
|
OP
|
$2,746.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.38 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,647.60
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cash Price |
$1,235.70
|
| Rate for Payer: Cigna of CA PPO |
$2,032.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,334.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,647.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,059.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| 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 |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,831.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$659.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,196.80
|
| Rate for Payer: Networks By Design Commercial |
$1,784.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,334.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,647.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,373.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,373.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,373.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,373.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
|
OP
|
$5,073.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,043.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: Cash Price |
$2,282.85
|
| Rate for Payer: Cigna of CA PPO |
$3,754.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,312.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,043.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,804.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,383.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,217.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,058.40
|
| Rate for Payer: Networks By Design Commercial |
$3,297.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,312.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,043.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
