|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
IP
|
$3,841.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.20 |
| Max. Negotiated Rate |
$3,264.85 |
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Cash Price |
$1,728.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.40
|
| Rate for Payer: Galaxy Health WC |
$3,264.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,561.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Multiplan Commercial |
$3,072.80
|
| Rate for Payer: Networks By Design Commercial |
$2,496.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,264.85
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
OP
|
$3,841.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,728.45
|
| Rate for Payer: Cash Price |
$1,728.45
|
| Rate for Payer: Cash Price |
$1,728.45
|
| Rate for Payer: Cigna of CA HMO |
$2,458.24
|
| Rate for Payer: Cigna of CA PPO |
$2,842.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$3,264.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,304.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,561.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$3,072.80
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,496.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,264.85
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,304.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,521.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,229.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
OP
|
$6,333.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$13,344.70 |
| Rate for Payer: Adventist Health Commercial |
$1,266.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,849.85
|
| Rate for Payer: Cash Price |
$2,849.85
|
| Rate for Payer: Cash Price |
$2,849.85
|
| Rate for Payer: Cigna of CA HMO |
$4,053.12
|
| Rate for Payer: Cigna of CA PPO |
$4,686.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,984.96
|
| Rate for Payer: EPIC Health Plan Senior |
$8,137.01
|
| Rate for Payer: Galaxy Health WC |
$5,383.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,799.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,252.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,903.59
|
| Rate for Payer: Multiplan Commercial |
$5,066.40
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$4,116.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,383.05
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,799.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,166.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,166.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,166.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,166.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,137.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
IP
|
$6,333.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,266.60 |
| Max. Negotiated Rate |
$5,383.05 |
| Rate for Payer: Adventist Health Commercial |
$1,266.60
|
| Rate for Payer: Cash Price |
$2,849.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,533.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,533.20
|
| Rate for Payer: Galaxy Health WC |
$5,383.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,799.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,412.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,920.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.92
|
| Rate for Payer: Multiplan Commercial |
$5,066.40
|
| Rate for Payer: Networks By Design Commercial |
$4,116.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,383.05
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,457.92
|
| Rate for Payer: Cigna of CA PPO |
$3,998.22
|
| 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 |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| 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 |
$4,322.40
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,701.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,701.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,701.50
|
| 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 REPAIR FLEXOR TENDON EA
|
Facility
|
IP
|
$9,432.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,886.40 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Adventist Health Commercial |
$1,886.40
|
| Rate for Payer: Cash Price |
$4,244.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,772.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,772.80
|
| Rate for Payer: Galaxy Health WC |
$8,017.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,291.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,593.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,838.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,263.68
|
| Rate for Payer: Multiplan Commercial |
$7,545.60
|
| Rate for Payer: Networks By Design Commercial |
$6,130.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,017.20
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
OP
|
$9,432.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$715.16 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Adventist Health Commercial |
$1,886.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 |
$4,244.40
|
| Rate for Payer: Cash Price |
$4,244.40
|
| Rate for Payer: Cash Price |
$4,244.40
|
| Rate for Payer: Cigna of CA HMO |
$6,036.48
|
| Rate for Payer: Cigna of CA PPO |
$6,979.68
|
| 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 |
$8,017.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,291.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,263.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$7,545.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,130.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,017.20
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,659.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,716.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,716.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
IP
|
$8,916.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,783.20 |
| Max. Negotiated Rate |
$7,578.60 |
| Rate for Payer: Adventist Health Commercial |
$1,783.20
|
| Rate for Payer: Cash Price |
$4,012.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,566.40
|
| Rate for Payer: Galaxy Health WC |
$7,578.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,349.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,946.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,397.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,519.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.84
|
| Rate for Payer: Multiplan Commercial |
$7,132.80
|
| Rate for Payer: Networks By Design Commercial |
$5,795.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,578.60
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
OP
|
$8,916.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$823.38 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,783.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$4,012.20
|
| Rate for Payer: Cash Price |
$4,012.20
|
| Rate for Payer: Cash Price |
$4,012.20
|
| Rate for Payer: Cigna of CA HMO |
$5,706.24
|
| Rate for Payer: Cigna of CA PPO |
$6,597.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,578.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,349.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,946.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$7,132.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,795.40
|
| Rate for Payer: Prime Health Services Commercial |
$7,578.60
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,349.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,458.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,458.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,458.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,458.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC REPAIR FOOT TENDON
|
Facility
|
OP
|
$8,219.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,643.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,698.55
|
| Rate for Payer: Cash Price |
$3,698.55
|
| Rate for Payer: Cash Price |
$3,698.55
|
| Rate for Payer: Cigna of CA HMO |
$5,260.16
|
| Rate for Payer: Cigna of CA PPO |
$6,082.06
|
| 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 |
$6,986.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,931.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,972.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,575.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,342.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,986.15
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,931.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,109.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,109.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,109.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,109.50
|
| 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 REPAIR FOOT TENDON
|
Facility
|
IP
|
$8,219.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,643.80 |
| Max. Negotiated Rate |
$6,986.15 |
| Rate for Payer: Adventist Health Commercial |
$1,643.80
|
| Rate for Payer: Cash Price |
$3,698.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,287.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,287.60
|
| Rate for Payer: Galaxy Health WC |
$6,986.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,931.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,482.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,131.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,087.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,972.56
|
| Rate for Payer: Multiplan Commercial |
$6,575.20
|
| Rate for Payer: Networks By Design Commercial |
$5,342.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,986.15
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
OP
|
$6,753.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: Cigna of CA HMO |
$4,321.92
|
| Rate for Payer: Cigna of CA PPO |
$4,997.22
|
| 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 |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| 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 |
$5,402.40
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,051.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,376.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,376.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,376.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,376.50
|
| 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 REPAIR HAND JOINT
|
Facility
|
IP
|
$6,753.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,350.60 |
| Max. Negotiated Rate |
$5,740.05 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Cash Price |
$3,038.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,701.20
|
| Rate for Payer: Galaxy Health WC |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,572.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,180.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| Rate for Payer: Multiplan Commercial |
$5,402.40
|
| Rate for Payer: Networks By Design Commercial |
$4,389.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.05
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
IP
|
$10,674.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,134.80 |
| Max. Negotiated Rate |
$9,072.90 |
| Rate for Payer: Adventist Health Commercial |
$2,134.80
|
| Rate for Payer: Cash Price |
$4,803.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,269.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,269.60
|
| Rate for Payer: Galaxy Health WC |
$9,072.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,404.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,066.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,607.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,561.76
|
| Rate for Payer: Multiplan Commercial |
$8,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,938.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,072.90
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
OP
|
$10,674.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.01 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$2,134.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$4,803.30
|
| Rate for Payer: Cash Price |
$4,803.30
|
| Rate for Payer: Cash Price |
$4,803.30
|
| Rate for Payer: Cigna of CA HMO |
$6,831.36
|
| Rate for Payer: Cigna of CA PPO |
$7,898.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$9,072.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,404.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,119.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,561.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$8,539.20
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$6,938.10
|
| Rate for Payer: Prime Health Services Commercial |
$9,072.90
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,404.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,337.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,337.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,337.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
OP
|
$10,590.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$2,118.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,833.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,211.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,555.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$4,765.50
|
| Rate for Payer: Cash Price |
$4,765.50
|
| Rate for Payer: Cash Price |
$4,765.50
|
| Rate for Payer: Cigna of CA HMO |
$6,777.60
|
| Rate for Payer: Cigna of CA PPO |
$7,836.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,833.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,211.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,555.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,850.51
|
| Rate for Payer: EPIC Health Plan Senior |
$6,555.93
|
| Rate for Payer: Galaxy Health WC |
$9,001.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,354.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,751.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,555.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,609.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,555.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,260.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,784.95
|
| Rate for Payer: Multiplan Commercial |
$8,472.00
|
| Rate for Payer: Multiplan WC |
$10,445.70
|
| Rate for Payer: Networks By Design Commercial |
$6,883.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,001.50
|
| Rate for Payer: Prime Health Services WC |
$10,339.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,354.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,295.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,295.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,295.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,555.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,833.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,211.52
|
| Rate for Payer: Vantage Medical Group Senior |
$6,555.93
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
IP
|
$10,590.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,118.00 |
| Max. Negotiated Rate |
$9,001.50 |
| Rate for Payer: Adventist Health Commercial |
$2,118.00
|
| Rate for Payer: Cash Price |
$4,765.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,236.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,236.00
|
| Rate for Payer: Galaxy Health WC |
$9,001.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,354.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,063.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,034.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,555.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,541.60
|
| Rate for Payer: Multiplan Commercial |
$8,472.00
|
| Rate for Payer: Networks By Design Commercial |
$6,883.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,001.50
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
OP
|
$4,038.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.76 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$807.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,817.10
|
| Rate for Payer: Cash Price |
$1,817.10
|
| Rate for Payer: Cash Price |
$1,817.10
|
| Rate for Payer: Cigna of CA HMO |
$2,584.32
|
| Rate for Payer: Cigna of CA PPO |
$2,988.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$3,432.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,693.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$3,230.40
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$2,624.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,432.30
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,422.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,019.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,019.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,019.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,019.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
IP
|
$4,038.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$807.60 |
| Max. Negotiated Rate |
$3,432.30 |
| Rate for Payer: Adventist Health Commercial |
$807.60
|
| Rate for Payer: Cash Price |
$1,817.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,615.20
|
| Rate for Payer: Galaxy Health WC |
$3,432.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,422.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,693.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,538.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,499.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.12
|
| Rate for Payer: Multiplan Commercial |
$3,230.40
|
| Rate for Payer: Networks By Design Commercial |
$2,624.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,432.30
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
IP
|
$4,249.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$849.80 |
| Max. Negotiated Rate |
$3,611.65 |
| Rate for Payer: Adventist Health Commercial |
$849.80
|
| Rate for Payer: Cash Price |
$1,912.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,699.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,699.60
|
| Rate for Payer: Galaxy Health WC |
$3,611.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,549.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,618.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,630.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.76
|
| Rate for Payer: Multiplan Commercial |
$3,399.20
|
| Rate for Payer: Networks By Design Commercial |
$2,761.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,611.65
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
OP
|
$4,249.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$849.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,912.05
|
| Rate for Payer: Cash Price |
$1,912.05
|
| Rate for Payer: Cash Price |
$1,912.05
|
| Rate for Payer: Cigna of CA HMO |
$2,719.36
|
| Rate for Payer: Cigna of CA PPO |
$3,144.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$3,611.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,549.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,834.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$3,399.20
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$2,761.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,611.65
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,549.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,124.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
IP
|
$746.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$634.10 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$298.40
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$497.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$284.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.04
|
| Rate for Payer: Multiplan Commercial |
$596.80
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
|
