|
HC FORESKIN MANIPULATION
|
Facility
|
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$1,271.60 |
| Rate for Payer: Adventist Health Commercial |
$299.20
|
| Rate for Payer: Cash Price |
$673.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$598.40
|
| Rate for Payer: EPIC Health Plan Senior |
$598.40
|
| Rate for Payer: Galaxy Health WC |
$1,271.60
|
| Rate for Payer: Global Benefits Group Commercial |
$897.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$997.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$569.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.04
|
| Rate for Payer: Multiplan Commercial |
$1,196.80
|
| Rate for Payer: Networks By Design Commercial |
$972.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,271.60
|
|
|
HC FO W/O JOINTS CF
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT L3933
|
| Hospital Charge Code |
905353933
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$131.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.34
|
| Rate for Payer: Blue Shield of California Commercial |
$236.16
|
| Rate for Payer: Blue Shield of California EPN |
$155.52
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$224.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$205.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$160.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.10
|
| Rate for Payer: United Healthcare All Other HMO |
$116.90
|
| Rate for Payer: United Healthcare HMO Rider |
$114.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC FO W/O JOINTS CF
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT L3933
|
| Hospital Charge Code |
905353933
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$224.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$160.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$120.10
|
| Rate for Payer: United Healthcare All Other HMO |
$116.90
|
| Rate for Payer: United Healthcare HMO Rider |
$114.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.80
|
|
|
HC FREE T4 BY EIA
|
Facility
|
OP
|
$92.05
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$89.04 |
| Rate for Payer: Adventist Health Commercial |
$18.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$60.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.04
|
| Rate for Payer: Blue Shield of California Commercial |
$61.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.69
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cash Price |
$41.42
|
| Rate for Payer: Cigna of CA HMO |
$58.91
|
| Rate for Payer: Cigna of CA PPO |
$68.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Senior |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$78.24
|
| Rate for Payer: Global Benefits Group Commercial |
$55.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$73.64
|
| Rate for Payer: Networks By Design Commercial |
$59.83
|
| Rate for Payer: Prime Health Services Commercial |
$78.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$55.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC FREE T4 BY EIA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$597.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$507.45 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$268.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.28
|
| Rate for Payer: Multiplan Commercial |
$477.60
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$34.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.27
|
| Rate for Payer: Blue Shield of California Commercial |
$113.73
|
| Rate for Payer: Blue Shield of California EPN |
$75.14
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC FSH
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$167.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.80
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FSH
|
Facility
|
OP
|
$148.72
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$183.53 |
| Rate for Payer: Adventist Health Commercial |
$29.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.53
|
| Rate for Payer: Blue Shield of California Commercial |
$99.49
|
| Rate for Payer: Blue Shield of California EPN |
$65.73
|
| Rate for Payer: Cash Price |
$66.92
|
| Rate for Payer: Cash Price |
$66.92
|
| Rate for Payer: Cigna of CA HMO |
$95.18
|
| Rate for Payer: Cigna of CA PPO |
$110.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.08
|
| Rate for Payer: EPIC Health Plan Senior |
$18.58
|
| Rate for Payer: Galaxy Health WC |
$126.41
|
| Rate for Payer: Global Benefits Group Commercial |
$89.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$118.98
|
| Rate for Payer: Networks By Design Commercial |
$96.67
|
| Rate for Payer: Prime Health Services Commercial |
$126.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO |
$15.05
|
| Rate for Payer: United Healthcare HMO Rider |
$15.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,900.80 |
| Max. Negotiated Rate |
$6,732.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,587.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5,844.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,849.12
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,253.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
915355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,900.80 |
| Max. Negotiated Rate |
$6,732.00 |
| Rate for Payer: Adventist Health Commercial |
$3,247.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,940.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,587.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5,844.96
|
| Rate for Payer: Blue Shield of California EPN |
$3,849.12
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,253.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,902.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,900.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,544.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,544.00
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,972.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2,893.18
|
| Rate for Payer: United Healthcare HMO Rider |
$2,830.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,593.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
915353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
IP
|
$4,060.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$3,451.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,624.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,624.00
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,708.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,546.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,513.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Multiplan Commercial |
$3,248.00
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
OP
|
$4,060.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$812.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cash Price |
$1,827.00
|
| Rate for Payer: Cigna of CA HMO |
$2,598.40
|
| Rate for Payer: Cigna of CA PPO |
$3,004.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,451.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,436.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,708.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,248.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,639.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,451.00
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,436.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,030.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,030.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,030.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,030.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
OP
|
$4,591.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$918.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: Cigna of CA HMO |
$2,938.24
|
| Rate for Payer: Cigna of CA PPO |
$3,397.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,902.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,984.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,902.35
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,754.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,295.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,295.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,295.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,295.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
IP
|
$4,591.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$918.20 |
| Max. Negotiated Rate |
$3,902.35 |
| Rate for Payer: Adventist Health Commercial |
$918.20
|
| Rate for Payer: Cash Price |
$2,065.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,836.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,836.40
|
| Rate for Payer: Galaxy Health WC |
$3,902.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,754.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,841.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,101.84
|
| Rate for Payer: Multiplan Commercial |
$3,672.80
|
| Rate for Payer: Networks By Design Commercial |
$2,984.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,902.35
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$3,391.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,596.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,596.00
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,520.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,469.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,324.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO |
$2,553.60
|
| Rate for Payer: Cigna of CA PPO |
$2,952.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,556.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,324.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,137.70
|
| Rate for Payer: EPIC Health Plan Senior |
$2,324.22
|
| Rate for Payer: Galaxy Health WC |
$3,391.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,811.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,324.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,661.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,324.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$957.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,928.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,114.45
|
| Rate for Payer: Multiplan Commercial |
$3,192.00
|
| Rate for Payer: Multiplan WC |
$3,703.23
|
| Rate for Payer: Networks By Design Commercial |
$2,593.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,391.50
|
| Rate for Payer: Prime Health Services WC |
$3,665.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,394.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,995.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,995.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,995.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,995.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,324.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,486.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,556.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,324.22
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
OP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,184.70 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,858.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,590.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,986.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,358.15
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Cigna of CA HMO |
$7,668.48
|
| Rate for Payer: Cigna of CA PPO |
$8,866.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,184.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,184.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,416.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,387.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,387.40
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,991.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,991.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,991.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,184.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
IP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,184.70 |
| Rate for Payer: Adventist Health Commercial |
$2,396.40
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,416.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
|
