|
HC HO METACARPL FX PREFAB
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
905353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC HO METACARPL FX PREFAB
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
915353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC HO METACARPL FX PREFAB
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
915353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Adventist Health Commercial |
$77.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.40
|
| Rate for Payer: Blue Shield of California Commercial |
$95.82
|
| Rate for Payer: Blue Shield of California Commercial |
$145.34
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC HO METACARPL FX PREFAB
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
905353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Adventist Health Commercial |
$77.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.40
|
| Rate for Payer: Blue Shield of California Commercial |
$95.82
|
| Rate for Payer: Blue Shield of California Commercial |
$145.34
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$101.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$111.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$133.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$192.10 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$160.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.48
|
| Rate for Payer: Blue Shield of California Commercial |
$39.19
|
| Rate for Payer: Blue Shield of California Commercial |
$104.19
|
| Rate for Payer: Blue Shield of California Commercial |
$59.24
|
| Rate for Payer: Blue Shield of California Commercial |
$157.52
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$158.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.98
|
| Rate for Payer: EPIC Health Plan Senior |
$24.65
|
| Rate for Payer: EPIC Health Plan Senior |
$24.65
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$143.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.03
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.15
|
| Rate for Payer: United Healthcare All Other HMO |
$18.15
|
| Rate for Payer: United Healthcare All Other HMO |
$18.15
|
| Rate for Payer: United Healthcare HMO Rider |
$18.15
|
| Rate for Payer: United Healthcare HMO Rider |
$18.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOOK/HAND, HVY DTY, VOL CLOS
|
Facility
|
IP
|
$5,648.18
|
|
|
Service Code
|
CPT L6722
|
| Hospital Charge Code |
905356722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,129.64 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,129.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cigna of CA HMO |
$3,953.73
|
| Rate for Payer: Cigna of CA PPO |
$3,953.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,953.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,259.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,259.27
|
| Rate for Payer: Galaxy Health WC |
$4,800.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,388.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,586.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,332.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.56
|
| Rate for Payer: Multiplan Commercial |
$4,518.54
|
| Rate for Payer: Networks By Design Commercial |
$3,671.32
|
| Rate for Payer: Prime Health Services Commercial |
$4,800.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2,063.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2,018.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,849.78
|
|
|
HC HOOK/HAND, HVY DTY, VOL CLOS
|
Facility
|
OP
|
$5,648.18
|
|
|
Service Code
|
CPT L6722
|
| Hospital Charge Code |
905356722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,355.56 |
| Max. Negotiated Rate |
$4,800.95 |
| Rate for Payer: Adventist Health Commercial |
$2,315.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,106.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,236.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,418.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.63
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cigna of CA HMO |
$3,953.73
|
| Rate for Payer: Cigna of CA PPO |
$3,953.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,800.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,800.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,953.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,259.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,259.27
|
| Rate for Payer: Galaxy Health WC |
$4,800.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,388.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,412.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,586.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,728.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,332.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,953.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,953.73
|
| Rate for Payer: Multiplan Commercial |
$4,518.54
|
| Rate for Payer: Networks By Design Commercial |
$2,824.09
|
| Rate for Payer: Prime Health Services Commercial |
$4,800.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,388.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,388.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2,063.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2,018.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,849.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,800.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,800.95
|
|
|
HC HOOK/HAND, HVY DTY, VOL CLOS
|
Facility
|
IP
|
$5,648.18
|
|
|
Service Code
|
CPT L6722
|
| Hospital Charge Code |
915356722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,129.64 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,129.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cigna of CA HMO |
$3,953.73
|
| Rate for Payer: Cigna of CA PPO |
$3,953.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,953.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,259.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,259.27
|
| Rate for Payer: Galaxy Health WC |
$4,800.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,388.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,586.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,332.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.56
|
| Rate for Payer: Multiplan Commercial |
$4,518.54
|
| Rate for Payer: Networks By Design Commercial |
$3,671.32
|
| Rate for Payer: Prime Health Services Commercial |
$4,800.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2,063.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2,018.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,849.78
|
|
|
HC HOOK/HAND, HVY DTY, VOL CLOS
|
Facility
|
OP
|
$5,648.18
|
|
|
Service Code
|
CPT L6722
|
| Hospital Charge Code |
915356722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,355.56 |
| Max. Negotiated Rate |
$4,800.95 |
| Rate for Payer: Adventist Health Commercial |
$2,315.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,106.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,236.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,418.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4,343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,863.63
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cigna of CA HMO |
$3,953.73
|
| Rate for Payer: Cigna of CA PPO |
$3,953.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,800.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,800.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,953.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,259.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,259.27
|
| Rate for Payer: Galaxy Health WC |
$4,800.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,388.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,412.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,586.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,728.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,332.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,355.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,953.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,953.73
|
| Rate for Payer: Multiplan Commercial |
$4,518.54
|
| Rate for Payer: Networks By Design Commercial |
$2,824.09
|
| Rate for Payer: Prime Health Services Commercial |
$4,800.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,388.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,388.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2,063.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2,018.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,849.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,800.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,800.95
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
IP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
905356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,310.37 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,310.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,586.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,160.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,865.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.44
|
| Rate for Payer: Multiplan Commercial |
$5,241.48
|
| Rate for Payer: Networks By Design Commercial |
$4,258.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
OP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
905356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,572.44 |
| Max. Negotiated Rate |
$5,569.07 |
| Rate for Payer: Adventist Health Commercial |
$2,686.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,603.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,913.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,965.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5,038.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,321.79
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,569.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,569.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,586.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,799.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,160.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,165.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,865.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,586.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,586.30
|
| Rate for Payer: Multiplan Commercial |
$5,241.48
|
| Rate for Payer: Networks By Design Commercial |
$3,275.93
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,931.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,931.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,569.07
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
OP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
915356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,572.44 |
| Max. Negotiated Rate |
$5,569.07 |
| Rate for Payer: Adventist Health Commercial |
$2,686.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,603.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,913.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,965.83
|
| Rate for Payer: Blue Shield of California Commercial |
$5,038.37
|
| Rate for Payer: Blue Shield of California Commercial |
$3,321.79
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,569.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,569.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,586.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,799.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,160.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,165.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,865.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,586.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,586.30
|
| Rate for Payer: Multiplan Commercial |
$5,241.48
|
| Rate for Payer: Networks By Design Commercial |
$3,275.93
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,931.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,931.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,569.07
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
IP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
915356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,310.37 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,310.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cash Price |
$2,948.33
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,586.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,160.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,865.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,572.44
|
| Rate for Payer: Multiplan Commercial |
$5,241.48
|
| Rate for Payer: Networks By Design Commercial |
$4,258.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
|
|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.74
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cigna of CA HMO |
$51.84
|
| Rate for Payer: Cigna of CA PPO |
$59.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
|
|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$68.85 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Senior |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.44
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
905353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.15
|
| Rate for Payer: Blue Shield of California Commercial |
$311.44
|
| Rate for Payer: Blue Shield of California Commercial |
$205.34
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
915353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
915353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.15
|
| Rate for Payer: Blue Shield of California Commercial |
$311.44
|
| Rate for Payer: Blue Shield of California Commercial |
$205.34
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$260.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$202.50
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HO W/O JOINTS CF
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT L3919
|
| Hospital Charge Code |
905353919
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$283.50
|
| Rate for Payer: Cigna of CA PPO |
$283.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$147.95
|
| Rate for Payer: United Healthcare HMO Rider |
$144.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.64
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
915355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.95
|
| Rate for Payer: Blue Shield of California Commercial |
$572.90
|
| Rate for Payer: Blue Shield of California Commercial |
$377.71
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
905355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$633.25 |
| Rate for Payer: Adventist Health Commercial |
$305.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$409.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$558.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$450.95
|
| Rate for Payer: Blue Shield of California Commercial |
$572.90
|
| Rate for Payer: Blue Shield of California Commercial |
$377.71
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$633.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$633.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$633.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$292.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$521.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$521.50
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$372.50
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$633.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$633.25
|
| Rate for Payer: Vantage Medical Group Senior |
$633.25
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
905355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HP ADDITION TEST SOCKET
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT L5628
|
| Hospital Charge Code |
915355628
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cigna of CA HMO |
$521.50
|
| Rate for Payer: Cigna of CA PPO |
$521.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$279.60
|
| Rate for Payer: United Healthcare All Other HMO |
$272.15
|
| Rate for Payer: United Healthcare HMO Rider |
$266.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.99
|
|
|
HC HP CANADIAN TYPE ENDOSKELETAL
|
Facility
|
IP
|
$30,883.00
|
|
|
Service Code
|
CPT L5341
|
| Hospital Charge Code |
915355340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,176.60 |
| Max. Negotiated Rate |
$26,250.55 |
| Rate for Payer: Adventist Health Commercial |
$6,176.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$13,897.35
|
| Rate for Payer: Cash Price |
$13,897.35
|
| Rate for Payer: Cigna of CA HMO |
$21,618.10
|
| Rate for Payer: Cigna of CA PPO |
$21,618.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21,618.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,353.20
|
| Rate for Payer: Galaxy Health WC |
$26,250.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,529.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19,610.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,220.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,411.92
|
| Rate for Payer: Multiplan Commercial |
$24,706.40
|
| Rate for Payer: Networks By Design Commercial |
$20,073.95
|
| Rate for Payer: Prime Health Services Commercial |
$26,250.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,590.39
|
| Rate for Payer: United Healthcare All Other HMO |
$11,281.56
|
| Rate for Payer: United Healthcare HMO Rider |
$11,037.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,114.18
|
|
