|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$25,475.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,095.00 |
| Max. Negotiated Rate |
$21,653.75 |
| Rate for Payer: Adventist Health Commercial |
$5,095.00
|
| Rate for Payer: Cash Price |
$11,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,190.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,190.00
|
| Rate for Payer: Galaxy Health WC |
$21,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,285.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,705.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,769.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,114.00
|
| Rate for Payer: Multiplan Commercial |
$20,380.00
|
| Rate for Payer: Networks By Design Commercial |
$16,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,653.75
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$25,475.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$21,653.75 |
| Rate for Payer: Adventist Health Commercial |
$5,095.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$11,463.75
|
| Rate for Payer: Cash Price |
$11,463.75
|
| Rate for Payer: Cash Price |
$11,463.75
|
| Rate for Payer: Cigna of CA HMO |
$16,304.00
|
| Rate for Payer: Cigna of CA PPO |
$18,851.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$21,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$15,285.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,991.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$20,380.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$16,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$21,653.75
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,285.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,737.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12,737.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12,737.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,737.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
OP
|
$14,866.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$12,636.10 |
| Rate for Payer: Adventist Health Commercial |
$2,973.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: Cigna of CA HMO |
$9,514.24
|
| Rate for Payer: Cigna of CA PPO |
$11,000.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$12,636.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,919.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,915.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,567.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$11,892.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$9,662.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,636.10
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,919.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,433.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,433.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,433.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,433.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
IP
|
$14,866.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,973.20 |
| Max. Negotiated Rate |
$12,636.10 |
| Rate for Payer: Adventist Health Commercial |
$2,973.20
|
| Rate for Payer: Cash Price |
$6,689.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,946.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,946.40
|
| Rate for Payer: Galaxy Health WC |
$12,636.10
|
| Rate for Payer: Global Benefits Group Commercial |
$8,919.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,915.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,663.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,202.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,567.84
|
| Rate for Payer: Multiplan Commercial |
$11,892.80
|
| Rate for Payer: Networks By Design Commercial |
$9,662.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,636.10
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$15,708.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$13,351.80 |
| Rate for Payer: Adventist Health Commercial |
$3,141.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$7,068.60
|
| Rate for Payer: Cash Price |
$7,068.60
|
| Rate for Payer: Cash Price |
$7,068.60
|
| Rate for Payer: Cigna of CA HMO |
$10,053.12
|
| Rate for Payer: Cigna of CA PPO |
$11,623.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$13,351.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,424.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,769.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$12,566.40
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$10,210.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,351.80
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,424.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,854.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,854.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,854.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,854.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$15,708.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,141.60 |
| Max. Negotiated Rate |
$13,351.80 |
| Rate for Payer: Adventist Health Commercial |
$3,141.60
|
| Rate for Payer: Cash Price |
$7,068.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,283.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,283.20
|
| Rate for Payer: Galaxy Health WC |
$13,351.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,424.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,984.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,723.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,769.92
|
| Rate for Payer: Multiplan Commercial |
$12,566.40
|
| Rate for Payer: Networks By Design Commercial |
$10,210.20
|
| Rate for Payer: Prime Health Services Commercial |
$13,351.80
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
IP
|
$14,396.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,879.20 |
| Max. Negotiated Rate |
$12,236.60 |
| Rate for Payer: Adventist Health Commercial |
$2,879.20
|
| Rate for Payer: Cash Price |
$6,478.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,758.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,758.40
|
| Rate for Payer: Galaxy Health WC |
$12,236.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,637.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,602.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,484.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,911.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,455.04
|
| Rate for Payer: Multiplan Commercial |
$11,516.80
|
| Rate for Payer: Networks By Design Commercial |
$9,357.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,236.60
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
OP
|
$14,396.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.66 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$2,879.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$6,478.20
|
| Rate for Payer: Cash Price |
$6,478.20
|
| Rate for Payer: Cash Price |
$6,478.20
|
| Rate for Payer: Cigna of CA HMO |
$9,213.44
|
| Rate for Payer: Cigna of CA PPO |
$10,653.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$12,236.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,637.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,602.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,455.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$11,516.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$9,357.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,236.60
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,637.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,198.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,198.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,198.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,198.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$13,347.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$11,344.95 |
| Rate for Payer: Adventist Health Commercial |
$2,669.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$6,006.15
|
| Rate for Payer: Cash Price |
$6,006.15
|
| Rate for Payer: Cash Price |
$6,006.15
|
| Rate for Payer: Cigna of CA HMO |
$8,542.08
|
| Rate for Payer: Cigna of CA PPO |
$9,876.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$11,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,008.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,203.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$10,677.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,675.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,344.95
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,673.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,673.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,673.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,673.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$13,347.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,669.40 |
| Max. Negotiated Rate |
$11,344.95 |
| Rate for Payer: Adventist Health Commercial |
$2,669.40
|
| Rate for Payer: Cash Price |
$6,006.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,338.80
|
| Rate for Payer: Galaxy Health WC |
$11,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,008.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,261.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,203.28
|
| Rate for Payer: Multiplan Commercial |
$10,677.60
|
| Rate for Payer: Networks By Design Commercial |
$8,675.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,344.95
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
IP
|
$7,491.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$6,367.35 |
| Rate for Payer: Adventist Health Commercial |
$1,498.20
|
| Rate for Payer: Cash Price |
$3,370.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,996.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,996.40
|
| Rate for Payer: Galaxy Health WC |
$6,367.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,494.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,996.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,854.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,636.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,797.84
|
| Rate for Payer: Multiplan Commercial |
$5,992.80
|
| Rate for Payer: Networks By Design Commercial |
$4,869.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,367.35
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
OP
|
$7,491.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Cash Price |
$3,370.95
|
| Rate for Payer: Cash Price |
$3,370.95
|
| Rate for Payer: Cash Price |
$3,370.95
|
| Rate for Payer: Cigna of CA HMO |
$4,794.24
|
| Rate for Payer: Cigna of CA PPO |
$5,543.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$6,367.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,494.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,996.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,797.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,470.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$5,992.80
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$4,869.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,367.35
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,494.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,745.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,745.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,745.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,745.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
IP
|
$8,507.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,701.40 |
| Max. Negotiated Rate |
$7,230.95 |
| Rate for Payer: Adventist Health Commercial |
$1,701.40
|
| Rate for Payer: Cash Price |
$3,828.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,402.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,402.80
|
| Rate for Payer: Galaxy Health WC |
$7,230.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,104.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,241.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,265.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.68
|
| Rate for Payer: Multiplan Commercial |
$6,805.60
|
| Rate for Payer: Networks By Design Commercial |
$5,529.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,230.95
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
OP
|
$8,507.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,701.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,828.15
|
| Rate for Payer: Cash Price |
$3,828.15
|
| Rate for Payer: Cash Price |
$3,828.15
|
| Rate for Payer: Cigna of CA HMO |
$5,444.48
|
| Rate for Payer: Cigna of CA PPO |
$6,295.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,230.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,104.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,805.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,529.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,230.95
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,104.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,253.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,253.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,253.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,253.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
IP
|
$14,930.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,986.00 |
| Max. Negotiated Rate |
$12,690.50 |
| Rate for Payer: Adventist Health Commercial |
$2,986.00
|
| Rate for Payer: Cash Price |
$6,718.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,972.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,972.00
|
| Rate for Payer: Galaxy Health WC |
$12,690.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,958.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,958.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,688.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,241.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,583.20
|
| Rate for Payer: Multiplan Commercial |
$11,944.00
|
| Rate for Payer: Networks By Design Commercial |
$9,704.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,690.50
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
OP
|
$14,930.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$891.99 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$2,986.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$6,718.50
|
| Rate for Payer: Cash Price |
$6,718.50
|
| Rate for Payer: Cash Price |
$6,718.50
|
| Rate for Payer: Cigna of CA HMO |
$9,555.20
|
| Rate for Payer: Cigna of CA PPO |
$11,048.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$12,690.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,958.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,958.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,583.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$11,944.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$9,704.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,690.50
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,958.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,465.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,465.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,465.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,465.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
OP
|
$6,803.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.46 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,360.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,061.35
|
| Rate for Payer: Cash Price |
$3,061.35
|
| Rate for Payer: Cash Price |
$3,061.35
|
| Rate for Payer: Cigna of CA HMO |
$4,353.92
|
| Rate for Payer: Cigna of CA PPO |
$5,034.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$5,782.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,081.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,632.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$5,442.40
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$4,421.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,782.55
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,081.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,401.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,401.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,401.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
IP
|
$6,803.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,360.60 |
| Max. Negotiated Rate |
$5,782.55 |
| Rate for Payer: Adventist Health Commercial |
$1,360.60
|
| Rate for Payer: Cash Price |
$3,061.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,721.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,721.20
|
| Rate for Payer: Galaxy Health WC |
$5,782.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,081.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,211.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,632.72
|
| Rate for Payer: Multiplan Commercial |
$5,442.40
|
| Rate for Payer: Networks By Design Commercial |
$4,421.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,782.55
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
IP
|
$1,186.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.20 |
| Max. Negotiated Rate |
$1,008.10 |
| Rate for Payer: Adventist Health Commercial |
$237.20
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.40
|
| Rate for Payer: EPIC Health Plan Senior |
$474.40
|
| Rate for Payer: Galaxy Health WC |
$1,008.10
|
| Rate for Payer: Global Benefits Group Commercial |
$711.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.64
|
| Rate for Payer: Multiplan Commercial |
$948.80
|
| Rate for Payer: Networks By Design Commercial |
$770.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.10
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
OP
|
$1,186.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.03 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$237.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,008.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$652.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cigna of CA HMO |
$759.04
|
| Rate for Payer: Cigna of CA PPO |
$877.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,008.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,008.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.40
|
| Rate for Payer: EPIC Health Plan Senior |
$474.40
|
| Rate for Payer: Galaxy Health WC |
$1,008.10
|
| Rate for Payer: Global Benefits Group Commercial |
$711.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$830.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$830.20
|
| Rate for Payer: Multiplan Commercial |
$948.80
|
| Rate for Payer: Networks By Design Commercial |
$770.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$711.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$593.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,008.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,008.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.10
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$728.94
|
| Rate for Payer: Blue Shield of California Commercial |
$726.44
|
| Rate for Payer: Blue Shield of California EPN |
$479.55
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$332.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.37
|
| Rate for Payer: Blue Shield of California Commercial |
$310.28
|
| Rate for Payer: Blue Shield of California EPN |
$204.83
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cigna of CA HMO |
$324.48
|
| Rate for Payer: Cigna of CA PPO |
$375.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.50
|
| Rate for Payer: United Healthcare All Other HMO |
$253.50
|
| Rate for Payer: United Healthcare HMO Rider |
$253.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
