|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
OP
|
$14,727.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.66 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$8,836.20
|
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Cigna of CA PPO |
$10,897.98
|
| 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 |
$12,517.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,836.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,045.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,822.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,534.48
|
| 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 |
$11,781.60
|
| Rate for Payer: Networks By Design Commercial |
$9,572.55
|
| Rate for Payer: Prime Health Services Commercial |
$12,517.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,836.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,836.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,363.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,363.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,363.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,363.50
|
| 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 OPEN TREAT INTERPHALANGEAL DIS
|
Facility
IP
|
$13,654.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,276.96 |
| Max. Negotiated Rate |
$11,605.90 |
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,461.60
|
| Rate for Payer: Galaxy Health WC |
$11,605.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,192.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,202.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,276.96
|
| Rate for Payer: Multiplan Commercial |
$10,923.20
|
| Rate for Payer: Networks By Design Commercial |
$8,875.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,605.90
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
OP
|
$13,654.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$11,605.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$8,192.40
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Cigna of CA PPO |
$10,103.96
|
| 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 |
$11,605.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,192.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10,240.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,276.96
|
| 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 |
$10,923.20
|
| Rate for Payer: Networks By Design Commercial |
$8,875.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,605.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,192.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,192.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,827.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,827.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,827.00
|
| 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 OPEN TREAT MANDIBULAR FX W/INT
|
Facility
IP
|
$9,277.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,226.48 |
| Max. Negotiated Rate |
$7,885.45 |
| Rate for Payer: Cash Price |
$4,174.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,710.80
|
| Rate for Payer: Galaxy Health WC |
$7,885.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,566.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,534.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.48
|
| Rate for Payer: Multiplan Commercial |
$7,421.60
|
| Rate for Payer: Networks By Design Commercial |
$6,030.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,885.45
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
OP
|
$9,277.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,566.20
|
| Rate for Payer: Cash Price |
$4,174.65
|
| Rate for Payer: Cash Price |
$4,174.65
|
| Rate for Payer: Cash Price |
$4,174.65
|
| Rate for Payer: Cigna of CA PPO |
$6,864.98
|
| 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 |
$7,885.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,566.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,957.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,226.48
|
| 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 |
$7,421.60
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Networks By Design Commercial |
$6,030.05
|
| Rate for Payer: Prime Health Services Commercial |
$7,885.45
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,566.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,566.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,638.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,638.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,638.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,638.50
|
| 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 OPEN TREAT METACARPAL FX SNGL
|
Facility
OP
|
$10,008.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$6,004.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,375.90
|
| Rate for Payer: Blue Shield of California EPN |
$5,844.67
|
| Rate for Payer: Cash Price |
$4,503.60
|
| Rate for Payer: Cash Price |
$4,503.60
|
| Rate for Payer: Cigna of CA PPO |
$7,405.92
|
| 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 |
$8,506.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,004.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,506.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$6,551.62
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,551.62
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,675.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,401.92
|
| 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 |
$8,006.40
|
| Rate for Payer: Networks By Design Commercial |
$6,505.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,506.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,004.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,004.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,004.80
|
| 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 |
$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 OPEN TREAT METACARPAL FX SNGL
|
Facility
IP
|
$10,008.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,401.92 |
| Max. Negotiated Rate |
$8,506.80 |
| Rate for Payer: Cash Price |
$4,503.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,003.20
|
| Rate for Payer: Galaxy Health WC |
$8,506.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,004.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,675.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,813.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,401.92
|
| Rate for Payer: Multiplan Commercial |
$8,006.40
|
| Rate for Payer: Networks By Design Commercial |
$6,505.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,506.80
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
IP
|
$15,274.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,665.76 |
| Max. Negotiated Rate |
$12,982.90 |
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,109.60
|
| Rate for Payer: Galaxy Health WC |
$12,982.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,164.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,819.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,665.76
|
| Rate for Payer: Multiplan Commercial |
$12,219.20
|
| Rate for Payer: Networks By Design Commercial |
$9,928.10
|
| Rate for Payer: Prime Health Services Commercial |
$12,982.90
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
OP
|
$15,274.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$891.99 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$9,164.40
|
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Cigna of CA PPO |
$11,302.76
|
| 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 |
$12,982.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,164.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,455.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,665.76
|
| 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 |
$12,219.20
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$9,928.10
|
| Rate for Payer: Prime Health Services Commercial |
$12,982.90
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$9,164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,637.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,637.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,637.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,637.00
|
| 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 OPEN TREAT TALUS FRACTURE
|
Facility
IP
|
$8,426.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,022.24 |
| Max. Negotiated Rate |
$7,162.10 |
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,370.40
|
| Rate for Payer: Galaxy Health WC |
$7,162.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,055.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,210.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,022.24
|
| Rate for Payer: Multiplan Commercial |
$6,740.80
|
| Rate for Payer: Networks By Design Commercial |
$5,476.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,162.10
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
OP
|
$8,426.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.46 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$5,055.60
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cash Price |
$3,791.70
|
| Rate for Payer: Cigna of CA PPO |
$6,235.24
|
| 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 |
$7,162.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,055.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,319.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,620.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,022.24
|
| 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 |
$6,740.80
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$5,476.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,162.10
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,055.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,055.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,213.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,213.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,213.00
|
| 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 OPERATING MICROSCOPE
|
Facility
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.04 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$602.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$602.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$657.60
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$931.60
|
| Rate for Payer: Dignity Health Media |
$931.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$931.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$822.00
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$931.60
|
| Rate for Payer: Vantage Medical Group Senior |
$931.60
|
|
|
HC OPERATING MICROSCOPE
|
Facility
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.04 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,187.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$286.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$832.33
|
| Rate for Payer: BCBS Transplant Transplant |
$838.20
|
| Rate for Payer: Blue Shield of California Commercial |
$825.63
|
| Rate for Payer: Blue Shield of California EPN |
$655.19
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cigna of CA HMO |
$894.08
|
| Rate for Payer: Cigna of CA PPO |
$1,033.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,047.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: IEHP Medi-Cal |
$183.93
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$183.93
|
| Rate for Payer: IEHP Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$838.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$838.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$838.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$335.28 |
| Max. Negotiated Rate |
$1,187.45 |
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
OP
|
$539.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$458.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.82
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$458.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$296.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$296.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$178.62
|
| Rate for Payer: BCBS Transplant Transplant |
$323.40
|
| Rate for Payer: Blue Shield of California Commercial |
$318.55
|
| Rate for Payer: Blue Shield of California EPN |
$252.79
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cigna of CA HMO |
$344.96
|
| Rate for Payer: Cigna of CA PPO |
$398.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$458.15
|
| Rate for Payer: Dignity Health Media |
$458.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$215.60
|
| Rate for Payer: Galaxy Health WC |
$458.15
|
| Rate for Payer: Global Benefits Group Commercial |
$323.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$404.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.36
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: Networks By Design Commercial |
$350.35
|
| Rate for Payer: Prime Health Services Commercial |
$458.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$323.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.50
|
| Rate for Payer: United Healthcare All Other HMO |
$269.50
|
| Rate for Payer: United Healthcare HMO Rider |
$269.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$458.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Vantage Medical Group Senior |
$458.15
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
IP
|
$539.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$458.15 |
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.60
|
| Rate for Payer: Galaxy Health WC |
$458.15
|
| Rate for Payer: Global Benefits Group Commercial |
$323.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.36
|
| Rate for Payer: Multiplan Commercial |
$431.20
|
| Rate for Payer: Networks By Design Commercial |
$350.35
|
| Rate for Payer: Prime Health Services Commercial |
$458.15
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
IP
|
$1,026.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.24 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
OP
|
$1,026.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$211.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$872.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$564.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$564.30
|
| Rate for Payer: BCBS Transplant Transplant |
$615.60
|
| Rate for Payer: Blue Shield of California Commercial |
$606.37
|
| Rate for Payer: Blue Shield of California EPN |
$481.19
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna of CA HMO |
$656.64
|
| Rate for Payer: Cigna of CA PPO |
$759.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$872.10
|
| Rate for Payer: Dignity Health Media |
$872.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$872.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$410.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$410.40
|
| Rate for Payer: Galaxy Health WC |
$872.10
|
| Rate for Payer: Global Benefits Group Commercial |
$615.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$769.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$684.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.24
|
| Rate for Payer: Multiplan Commercial |
$820.80
|
| Rate for Payer: Networks By Design Commercial |
$666.90
|
| Rate for Payer: Prime Health Services Commercial |
$872.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$615.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$615.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$615.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$513.00
|
| Rate for Payer: United Healthcare All Other HMO |
$513.00
|
| Rate for Payer: United Healthcare HMO Rider |
$513.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$513.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$872.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$872.10
|
| Rate for Payer: Vantage Medical Group Senior |
$872.10
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
IP
|
$10,626.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,550.24 |
| Max. Negotiated Rate |
$9,032.10 |
| Rate for Payer: Cash Price |
$4,781.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,250.40
|
| Rate for Payer: Galaxy Health WC |
$9,032.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,375.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,087.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,048.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,550.24
|
| Rate for Payer: Multiplan Commercial |
$8,500.80
|
| Rate for Payer: Networks By Design Commercial |
$6,906.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,032.10
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
OP
|
$10,626.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$9,032.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,375.60
|
| Rate for Payer: Cash Price |
$4,781.70
|
| Rate for Payer: Cash Price |
$4,781.70
|
| Rate for Payer: Cash Price |
$4,781.70
|
| Rate for Payer: Cigna of CA PPO |
$7,863.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$9,032.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,375.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,969.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,477.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,477.82
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,087.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,550.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$8,500.80
|
| Rate for Payer: Networks By Design Commercial |
$6,906.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,032.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,375.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,375.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,313.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,313.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,313.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
IP
|
$138.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
OP
|
$138.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$33.12 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$75.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.22
|
| Rate for Payer: BCBS Transplant Transplant |
$82.80
|
| Rate for Payer: Blue Shield of California Commercial |
$101.71
|
| Rate for Payer: Blue Shield of California EPN |
$80.59
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Media |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$92.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69.00
|
| Rate for Payer: United Healthcare HMO Rider |
$69.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
OP
|
$418.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$256.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$249.04
|
| Rate for Payer: BCBS Transplant Transplant |
$250.80
|
| Rate for Payer: Blue Shield of California Commercial |
$247.04
|
| Rate for Payer: Blue Shield of California EPN |
$196.04
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO |
$267.52
|
| Rate for Payer: Cigna of CA PPO |
$309.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$313.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
IP
|
$418.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$100.32 |
| Max. Negotiated Rate |
$355.30 |
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.32
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
|
