|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.31 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.39
|
| Rate for Payer: Blue Shield of California Commercial |
$90.31
|
| Rate for Payer: Blue Shield of California EPN |
$59.67
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cigna of CA HMO |
$86.40
|
| Rate for Payer: Cigna of CA PPO |
$99.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.18
|
| Rate for Payer: EPIC Health Plan Senior |
$5.32
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.31
|
| Rate for Payer: United Healthcare All Other HMO |
$4.31
|
| Rate for Payer: United Healthcare HMO Rider |
$4.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.85
|
| Rate for Payer: Vantage Medical Group Senior |
$5.32
|
|
|
HC OCCULT BLOOD OTHR SOURCE
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
900911536
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$118.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.14
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$118.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$87.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.88
|
| Rate for Payer: EPIC Health Plan Senior |
$79.17
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$129.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$79.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.09
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| 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 |
$79.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$118.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.09
|
| Rate for Payer: Vantage Medical Group Senior |
$79.17
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$56.95 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$36.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$241.33
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.40
|
| Rate for Payer: Blue Shield of California Commercial |
$241.33
|
| Rate for Payer: Blue Shield of California EPN |
$158.92
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cash Price |
$179.85
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$143.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Adventist Health Commercial |
$78.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.63
|
| Rate for Payer: Blue Shield of California Commercial |
$140.96
|
| Rate for Payer: Blue Shield of California EPN |
$92.83
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$162.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.70
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.35
|
| Rate for Payer: Vantage Medical Group Senior |
$162.35
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
915352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
915352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.84 |
| Max. Negotiated Rate |
$162.35 |
| Rate for Payer: Adventist Health Commercial |
$78.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.63
|
| Rate for Payer: Blue Shield of California Commercial |
$140.96
|
| Rate for Payer: Blue Shield of California EPN |
$92.83
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cash Price |
$105.05
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$162.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$133.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$133.70
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.35
|
| Rate for Payer: Vantage Medical Group Senior |
$162.35
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
IP
|
$25.58
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
OP
|
$25.58
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Adventist Health Commercial |
$5.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.71
|
| Rate for Payer: Cash Price |
$14.07
|
| Rate for Payer: Cigna of CA HMO |
$16.37
|
| Rate for Payer: Cigna of CA PPO |
$18.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Senior |
$10.23
|
| Rate for Payer: Galaxy Health WC |
$21.74
|
| Rate for Payer: Global Benefits Group Commercial |
$15.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.91
|
| Rate for Payer: Multiplan Commercial |
$20.46
|
| Rate for Payer: Networks By Design Commercial |
$16.63
|
| Rate for Payer: Prime Health Services Commercial |
$21.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.79
|
| Rate for Payer: United Healthcare All Other HMO |
$12.79
|
| Rate for Payer: United Healthcare HMO Rider |
$12.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.74
|
| Rate for Payer: Vantage Medical Group Senior |
$21.74
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
IP
|
$8,954.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,790.80 |
| Max. Negotiated Rate |
$7,610.90 |
| Rate for Payer: Adventist Health Commercial |
$1,790.80
|
| Rate for Payer: Cash Price |
$4,924.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,581.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,581.60
|
| Rate for Payer: Galaxy Health WC |
$7,610.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,372.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,972.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,411.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,542.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,148.96
|
| Rate for Payer: Multiplan Commercial |
$7,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,820.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,610.90
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
OP
|
$8,954.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,790.80
|
| 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 |
$4,924.70
|
| Rate for Payer: Cash Price |
$4,924.70
|
| Rate for Payer: Cash Price |
$4,924.70
|
| Rate for Payer: Cigna of CA HMO |
$5,730.56
|
| Rate for Payer: Cigna of CA PPO |
$6,625.96
|
| 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 |
$7,610.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,372.40
|
| 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 |
$5,972.32
|
| 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 |
$2,148.96
|
| 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 |
$7,163.20
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$5,820.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,610.90
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,372.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,477.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,477.00
|
| 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 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 |
$14,011.25
|
| 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 |
$14,011.25
|
| Rate for Payer: Cash Price |
$14,011.25
|
| Rate for Payer: Cash Price |
$14,011.25
|
| 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 |
$8,176.30
|
| Rate for Payer: Cash Price |
$8,176.30
|
| Rate for Payer: Cash Price |
$8,176.30
|
| 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 |
$8,176.30
|
| 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 |
$8,639.40
|
| Rate for Payer: Cash Price |
$8,639.40
|
| Rate for Payer: Cash Price |
$8,639.40
|
| 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 |
$8,639.40
|
| 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 |
$7,917.80
|
| 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 |
$7,917.80
|
| Rate for Payer: Cash Price |
$7,917.80
|
| Rate for Payer: Cash Price |
$7,917.80
|
| 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 |
$7,340.85
|
| Rate for Payer: Cash Price |
$7,340.85
|
| Rate for Payer: Cash Price |
$7,340.85
|
| 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
|
|
