|
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: Vantage Medical Group Senior |
$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 |
$115.61
|
| Rate for Payer: Blue Shield of California Commercial |
$96.84
|
| Rate for Payer: Blue Shield of California Commercial |
$146.88
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| 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
|
|
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| 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 |
$124.15
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| 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 |
$124.15
|
| 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 |
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 |
$115.61
|
| Rate for Payer: Blue Shield of California Commercial |
$96.84
|
| Rate for Payer: Blue Shield of California Commercial |
$146.88
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$104.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| 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 |
$11.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.91
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.09
|
| 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 |
$16.41
|
| Rate for Payer: Cash Price |
$11.51
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.91
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.09
|
| 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
|
OP
|
$8,954.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$1,790.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: Cash Price |
$4,029.30
|
| Rate for Payer: Cash Price |
$4,029.30
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,267.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| 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/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,685.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,148.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| 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 |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
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: Cash Price |
$4,029.30
|
| Rate for Payer: Adventist Health Commercial |
$1,790.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,267.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,685.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,282.86
|
| 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 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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,832.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| 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/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,176.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,114.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| 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 |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,832.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$16,176.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,030.25
|
| 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 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: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Adventist Health Commercial |
$2,973.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,406.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,439.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,567.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,406.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,439.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,770.94
|
| 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: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
| Rate for Payer: Adventist Health Commercial |
$3,141.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,974.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,769.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$15,708.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,995.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,974.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,267.72
|
| 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/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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,995.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,974.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,267.72
|
| 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/THUMB FX EA
|
Facility
|
OP
|
$15,708.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$13,351.80 |
| Rate for Payer: Adventist Health Commercial |
$6,440.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,134.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,974.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,769.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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: TriValley Medical Group Commercial/Senior |
$9,424.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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 |
$12,236.60 |
| Rate for Payer: Adventist Health Commercial |
$2,879.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,077.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,141.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$428.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,455.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,077.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,141.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,493.64
|
| 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 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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,475.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,203.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$13,347.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,342.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,475.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,874.73
|
| 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 INTERPHALANGEAL DIS
|
Facility
|
OP
|
$13,347.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$11,344.95 |
| Rate for Payer: Adventist Health Commercial |
$5,472.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,408.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,342.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,475.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,203.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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: TriValley Medical Group Commercial/Senior |
$8,008.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,342.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,475.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,874.73
|
| 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
|
OP
|
$7,491.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$12,562.92 |
| Rate for Payer: Adventist Health Commercial |
$1,498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,323.00
|
| 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 |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| 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/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,756.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,184.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,797.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| 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 |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,243.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,756.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,419.69
|
| 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 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 |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,701.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,954.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,401.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
