|
HC PART HAND REST REPLACEMT GLOVE
|
Facility
|
IP
|
$1,549.00
|
|
|
Service Code
|
CPT L6915
|
| Hospital Charge Code |
905356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$309.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$309.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna of CA HMO |
$1,084.30
|
| Rate for Payer: Cigna of CA PPO |
$1,084.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$619.60
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$983.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Multiplan Commercial |
$1,239.20
|
| Rate for Payer: Networks By Design Commercial |
$1,006.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.34
|
| Rate for Payer: United Healthcare All Other HMO |
$565.85
|
| Rate for Payer: United Healthcare HMO Rider |
$553.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.30
|
|
|
HC PART HAND REST REPLACEMT GLOVE
|
Facility
|
OP
|
$1,549.00
|
|
|
Service Code
|
CPT L6915
|
| Hospital Charge Code |
905356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$371.76 |
| Max. Negotiated Rate |
$1,316.65 |
| Rate for Payer: Adventist Health Commercial |
$635.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,316.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$851.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,161.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$937.61
|
| Rate for Payer: Blue Shield of California Commercial |
$785.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.18
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cigna of CA HMO |
$1,084.30
|
| Rate for Payer: Cigna of CA PPO |
$1,084.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,316.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,316.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,316.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.60
|
| Rate for Payer: EPIC Health Plan Senior |
$619.60
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$701.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$983.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$792.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$913.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,084.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,084.30
|
| Rate for Payer: Multiplan Commercial |
$1,239.20
|
| Rate for Payer: Networks By Design Commercial |
$774.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$929.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$929.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.34
|
| Rate for Payer: United Healthcare All Other HMO |
$565.85
|
| Rate for Payer: United Healthcare HMO Rider |
$553.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,316.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,316.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,316.65
|
|
|
HC PART HAND REST W/GLOVE THMB
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
905356900
|
|
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 |
$1,947.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,474.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,631.53
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,244.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| 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 PART HAND REST W/GLOVE THMB
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
915356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.32
|
| Rate for Payer: Multiplan Commercial |
$2,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| 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
|
|
|
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 |
$1,947.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2,474.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,631.53
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,244.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| 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 PART HAND REST W/GLOVE THMB
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
905356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,252.60
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,043.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,898.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.32
|
| Rate for Payer: Multiplan Commercial |
$2,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| 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
|
|
|
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 |
$6,943.76 |
| 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 |
$1,361.00
|
| 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 |
$3,062.25
|
| Rate for Payer: Cash Price |
$3,062.25
|
| Rate for Payer: Cash Price |
$3,062.25
|
| 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 |
$6,312.51
|
| 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 |
$4,763.50
|
| 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 |
$5,784.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.00
|
| 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 |
$4,321.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.20
|
| 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 |
$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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$6,805.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$6,943.76 |
| Rate for Payer: Adventist Health Commercial |
$2,790.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,622.30
|
| 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 |
$3,062.25
|
| Rate for Payer: Cash Price |
$3,062.25
|
| Rate for Payer: Cash Price |
$3,062.25
|
| 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 |
$6,312.51
|
| 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 |
$4,763.50
|
| 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 |
$5,784.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,083.00
|
| 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 |
$4,321.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,633.20
|
| 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 |
$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: TriValley Medical Group Commercial/Senior |
$4,083.00
|
| 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 PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$6,805.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
456
|
| 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 |
$3,062.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,763.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,321.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,014.95
|
| 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 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 |
$3,062.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,763.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,321.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,014.95
|
| 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 |
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 |
$2,347.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,966.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,982.18
|
| Rate for Payer: Cash Price |
$1,745.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,462.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,407.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.02
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,462.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.02
|
| 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 |
$2,520.70
|
| 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 |
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 |
$2,347.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,966.15
|
| Rate for Payer: Blue Shield of California Commercial |
$2,982.18
|
| Rate for Payer: Cash Price |
$1,745.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,462.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,407.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.02
|
| 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 |
915356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,462.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,288.02
|
| 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 |
$2,520.70
|
| 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 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 |
$2,445.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,048.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,106.76
|
| Rate for Payer: Cash Price |
$1,818.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,565.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,466.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,383.60
|
| 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
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
915356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,818.00
|
| Rate for Payer: Cash Price |
$1,818.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,565.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,383.60
|
| 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 |
$2,626.00
|
| 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 |
905356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,818.00
|
| Rate for Payer: Cash Price |
$1,818.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,565.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,383.60
|
| 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 |
$2,626.00
|
| 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 |
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 |
$2,445.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,048.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,106.76
|
| Rate for Payer: Cash Price |
$1,818.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,565.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,466.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,383.60
|
| 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 |
$3,558.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,534.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,020.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,665.13
|
| 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 |
$6,720.95 |
| Rate for Payer: Adventist Health Commercial |
$1,581.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,558.15
|
| Rate for Payer: Cash Price |
$3,558.15
|
| Rate for Payer: Cash Price |
$3,558.15
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,534.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| 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/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,020.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$505.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,897.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| 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 |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
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 |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,630.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$3,667.95
|
| Rate for Payer: Cash Price |
$3,667.95
|
| Rate for Payer: Cash Price |
$3,667.95
|
| 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 |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,705.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| 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/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,175.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,956.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| 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 |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
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 |
$3,667.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,705.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,175.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,809.09
|
| 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
|
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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cash Price |
$5,670.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$8,001.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,434.00
|
| 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 |
$8,190.00
|
| 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
|
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 |
$7,626.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,388.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,689.40
|
| Rate for Payer: Cash Price |
$5,670.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$8,001.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,573.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,434.00
|
| 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 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 |
$129.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$201.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$182.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.92
|
| 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
|
|
