|
HC PART HAND REST W/GLOVE THMB
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
915356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$772.32 |
| Max. Negotiated Rate |
$2,735.30 |
| Rate for Payer: Adventist Health Commercial |
$1,319.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,769.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,413.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,863.87
|
| Rate for Payer: Blue Shield of California Commercial |
$2,374.88
|
| Rate for Payer: Blue Shield of California EPN |
$1,563.95
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,735.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,735.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,100.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,991.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,252.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,252.60
|
| Rate for Payer: Multiplan Commercial |
$2,574.40
|
| Rate for Payer: Networks By Design Commercial |
$1,609.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,207.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1,175.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,735.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,735.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,735.30
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$6,805.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,361.00
|
| 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 |
$3,742.75
|
| Rate for Payer: Cash Price |
$3,742.75
|
| Rate for Payer: Cash Price |
$3,742.75
|
| Rate for Payer: Cigna of CA HMO |
$4,355.20
|
| Rate for Payer: Cigna of CA PPO |
$5,035.70
|
| 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 |
$5,784.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.00
|
| 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 |
$4,538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.20
|
| 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 |
$5,444.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,423.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,784.25
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,083.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,402.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,402.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,402.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,402.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$6,805.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,361.00 |
| Max. Negotiated Rate |
$5,784.25 |
| Rate for Payer: Adventist Health Commercial |
$1,361.00
|
| Rate for Payer: Cash Price |
$3,742.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,722.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,722.00
|
| Rate for Payer: Galaxy Health WC |
$5,784.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,538.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,592.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,212.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.20
|
| Rate for Payer: Multiplan Commercial |
$5,444.00
|
| Rate for Payer: Networks By Design Commercial |
$4,423.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,784.25
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
OP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
905356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$930.72 |
| Max. Negotiated Rate |
$3,296.30 |
| Rate for Payer: Adventist Health Commercial |
$1,589.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,132.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,908.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,246.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,861.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,884.71
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,296.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,296.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,545.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$930.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.60
|
| Rate for Payer: Multiplan Commercial |
$3,102.40
|
| Rate for Payer: Networks By Design Commercial |
$1,939.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,326.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,326.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,296.30
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
905356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,477.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$930.72
|
| Rate for Payer: Multiplan Commercial |
$3,102.40
|
| Rate for Payer: Networks By Design Commercial |
$1,939.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
915356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,477.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$930.72
|
| Rate for Payer: Multiplan Commercial |
$3,102.40
|
| Rate for Payer: Networks By Design Commercial |
$1,939.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
OP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
915356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$930.72 |
| Max. Negotiated Rate |
$3,296.30 |
| Rate for Payer: Adventist Health Commercial |
$1,589.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,132.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,908.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,246.14
|
| Rate for Payer: Blue Shield of California Commercial |
$2,861.96
|
| Rate for Payer: Blue Shield of California EPN |
$1,884.71
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,296.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,296.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,545.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$930.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.60
|
| Rate for Payer: Multiplan Commercial |
$3,102.40
|
| Rate for Payer: Networks By Design Commercial |
$1,939.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,326.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,326.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,296.30
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
905356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,539.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.60
|
| Rate for Payer: Multiplan Commercial |
$3,232.00
|
| Rate for Payer: Networks By Design Commercial |
$2,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
915356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,539.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.60
|
| Rate for Payer: Multiplan Commercial |
$3,232.00
|
| Rate for Payer: Networks By Design Commercial |
$2,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
915356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$969.60 |
| Max. Negotiated Rate |
$3,434.00 |
| Rate for Payer: Adventist Health Commercial |
$1,656.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,222.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,030.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,339.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,981.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,963.44
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,434.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,434.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,439.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,627.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,828.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,828.00
|
| Rate for Payer: Multiplan Commercial |
$3,232.00
|
| Rate for Payer: Networks By Design Commercial |
$2,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,424.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,424.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,434.00
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
905356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$969.60 |
| Max. Negotiated Rate |
$3,434.00 |
| Rate for Payer: Adventist Health Commercial |
$1,656.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,222.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,030.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,339.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2,981.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,963.44
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,434.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,434.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,439.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,627.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,828.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,828.00
|
| Rate for Payer: Multiplan Commercial |
$3,232.00
|
| Rate for Payer: Networks By Design Commercial |
$2,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,424.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,424.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,434.00
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
|
IP
|
$7,907.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,581.40 |
| Max. Negotiated Rate |
$6,720.95 |
| Rate for Payer: Adventist Health Commercial |
$1,581.40
|
| Rate for Payer: Cash Price |
$4,348.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,162.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,162.80
|
| Rate for Payer: Galaxy Health WC |
$6,720.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,744.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,012.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,894.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,897.68
|
| Rate for Payer: Multiplan Commercial |
$6,325.60
|
| Rate for Payer: Networks By Design Commercial |
$5,139.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,720.95
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
|
OP
|
$7,907.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.06 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,581.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,348.85
|
| Rate for Payer: Cash Price |
$4,348.85
|
| Rate for Payer: Cash Price |
$4,348.85
|
| Rate for Payer: Cigna of CA HMO |
$5,060.48
|
| Rate for Payer: Cigna of CA PPO |
$5,851.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$6,720.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,744.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,273.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,897.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$6,325.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$5,139.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,720.95
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,744.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,953.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,953.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,953.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,953.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
|
OP
|
$8,151.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$4,483.05
|
| Rate for Payer: Cash Price |
$4,483.05
|
| Rate for Payer: Cash Price |
$4,483.05
|
| Rate for Payer: Cigna of CA HMO |
$5,216.64
|
| Rate for Payer: Cigna of CA PPO |
$6,031.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$6,928.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$6,520.80
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$5,298.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,928.35
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,890.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,075.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,075.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,075.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,075.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
|
IP
|
$8,151.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,630.20 |
| Max. Negotiated Rate |
$6,928.35 |
| Rate for Payer: Adventist Health Commercial |
$1,630.20
|
| Rate for Payer: Cash Price |
$4,483.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,260.40
|
| Rate for Payer: Galaxy Health WC |
$6,928.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,890.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,436.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,105.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,045.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.24
|
| Rate for Payer: Multiplan Commercial |
$6,520.80
|
| Rate for Payer: Networks By Design Commercial |
$5,298.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,928.35
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
OP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
915356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$10,710.00 |
| Rate for Payer: Adventist Health Commercial |
$5,166.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,930.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,297.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9,298.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,123.60
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,710.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,820.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,820.00
|
| Rate for Payer: Multiplan Commercial |
$10,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,560.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,560.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,710.00
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
OP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
905356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,024.00 |
| Max. Negotiated Rate |
$10,710.00 |
| Rate for Payer: Adventist Health Commercial |
$5,166.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,930.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,297.92
|
| Rate for Payer: Blue Shield of California Commercial |
$9,298.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,123.60
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,710.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,820.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,820.00
|
| Rate for Payer: Multiplan Commercial |
$10,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,560.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,560.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,710.00
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
IP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
905356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
IP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
915356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,024.00
|
| Rate for Payer: Multiplan Commercial |
$10,080.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.86
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.86
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASTE MEDIHONEY TUBE .5FL OZ
|
Facility
|
OP
|
$39.69
|
|
|
Service Code
|
CPT A6240
|
| Hospital Charge Code |
901698328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.37
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cigna of CA HMO |
$25.40
|
| Rate for Payer: Cigna of CA PPO |
$29.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Senior |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.74
|
| Rate for Payer: Global Benefits Group Commercial |
$23.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.78
|
| Rate for Payer: Multiplan Commercial |
$31.75
|
| Rate for Payer: Networks By Design Commercial |
$25.80
|
| Rate for Payer: Prime Health Services Commercial |
$33.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.84
|
| Rate for Payer: United Healthcare All Other HMO |
$19.84
|
| Rate for Payer: United Healthcare HMO Rider |
$19.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.74
|
| Rate for Payer: Vantage Medical Group Senior |
$33.74
|
|
|
HC PASTE MEDIHONEY TUBE .5FL OZ
|
Facility
|
IP
|
$39.69
|
|
|
Service Code
|
CPT A6240
|
| Hospital Charge Code |
901698328
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.94 |
| Max. Negotiated Rate |
$33.74 |
| Rate for Payer: Adventist Health Commercial |
$7.94
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.88
|
| Rate for Payer: EPIC Health Plan Senior |
$15.88
|
| Rate for Payer: Galaxy Health WC |
$33.74
|
| Rate for Payer: Global Benefits Group Commercial |
$23.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.53
|
| Rate for Payer: Multiplan Commercial |
$31.75
|
| Rate for Payer: Networks By Design Commercial |
$25.80
|
| Rate for Payer: Prime Health Services Commercial |
$33.74
|
|
