|
HC RENAL SELECTIVE INC AO
|
Facility
|
OP
|
$7,714.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.79 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$3,471.30
|
| Rate for Payer: Cash Price |
$3,471.30
|
| Rate for Payer: Cash Price |
$3,471.30
|
| Rate for Payer: Cigna of CA HMO |
$4,936.96
|
| Rate for Payer: Cigna of CA PPO |
$5,708.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,399.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$6,556.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,628.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$382.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,898.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,171.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,014.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.90
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,628.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,857.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
|
OP
|
$433.03
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$368.08 |
| Rate for Payer: Adventist Health Commercial |
$86.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$277.88
|
| Rate for Payer: Cash Price |
$194.86
|
| Rate for Payer: Cash Price |
$194.86
|
| Rate for Payer: Cigna of CA HMO |
$277.14
|
| Rate for Payer: Cigna of CA PPO |
$320.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.21
|
| Rate for Payer: EPIC Health Plan Senior |
$173.21
|
| Rate for Payer: Galaxy Health WC |
$368.08
|
| Rate for Payer: Global Benefits Group Commercial |
$259.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$255.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$346.42
|
| Rate for Payer: Networks By Design Commercial |
$281.47
|
| Rate for Payer: Prime Health Services Commercial |
$368.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.51
|
| Rate for Payer: United Healthcare All Other HMO |
$216.51
|
| Rate for Payer: United Healthcare HMO Rider |
$216.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.08
|
| Rate for Payer: Vantage Medical Group Senior |
$368.08
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
|
IP
|
$433.03
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$368.08 |
| Rate for Payer: Adventist Health Commercial |
$86.61
|
| Rate for Payer: Cash Price |
$194.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$303.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.21
|
| Rate for Payer: EPIC Health Plan Senior |
$173.21
|
| Rate for Payer: Galaxy Health WC |
$368.08
|
| Rate for Payer: Global Benefits Group Commercial |
$259.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$274.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$255.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.93
|
| Rate for Payer: Multiplan Commercial |
$346.42
|
| Rate for Payer: Networks By Design Commercial |
$281.47
|
| Rate for Payer: Prime Health Services Commercial |
$368.08
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
IP
|
$3,481.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$696.20 |
| Max. Negotiated Rate |
$2,958.85 |
| Rate for Payer: Adventist Health Commercial |
$696.20
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,436.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,392.40
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,210.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,053.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.44
|
| Rate for Payer: Multiplan Commercial |
$2,784.80
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$2,958.85 |
| Rate for Payer: Adventist Health Commercial |
$696.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,373.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,233.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,220.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1,465.50
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cash Price |
$1,566.45
|
| Rate for Payer: Cigna of CA HMO |
$2,227.84
|
| Rate for Payer: Cigna of CA PPO |
$2,575.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,436.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,210.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,784.80
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$13,682.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,736.40 |
| Max. Negotiated Rate |
$11,629.70 |
| Rate for Payer: Adventist Health Commercial |
$2,736.40
|
| Rate for Payer: Cash Price |
$6,156.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,577.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,472.80
|
| Rate for Payer: Galaxy Health WC |
$11,629.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,209.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,688.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,072.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,283.68
|
| Rate for Payer: Multiplan Commercial |
$10,945.60
|
| Rate for Payer: Networks By Design Commercial |
$8,893.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,629.70
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$13,682.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$2,736.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$6,156.90
|
| Rate for Payer: Cash Price |
$6,156.90
|
| Rate for Payer: Cash Price |
$6,156.90
|
| Rate for Payer: Cigna of CA HMO |
$8,756.48
|
| Rate for Payer: Cigna of CA PPO |
$10,124.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,577.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$11,629.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,209.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,688.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,283.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$10,945.60
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$8,893.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,629.70
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,209.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,841.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,841.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,688.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,439.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,266.19
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,688.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,439.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$1,920.50
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,720.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,560.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.22
|
| 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,720.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| 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/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| 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 |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
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 |
$18,623.90 |
| Rate for Payer: Adventist Health Commercial |
$1,266.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,433.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,623.90
|
| Rate for Payer: EPIC Health Plan Senior |
$12,415.93
|
| 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/Senior |
$18,511.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,021.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,133.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,221.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,124.86
|
| 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 |
$11,287.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,433.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,021.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,736.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| 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 |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$6,312.51
|
| 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 |
$3,782.10
|
| 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 |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| 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 |
$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 |
$4,208.34
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,602.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,989.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,564.88
|
| 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 |
$3,171.00
|
| 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 |
$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 |
$6,312.51
|
| 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 |
$6,602.40
|
| 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 |
$8,017.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,989.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$715.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,263.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$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 |
$4,208.34
|
| 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 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 |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,783.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$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 |
$6,312.51
|
| 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 |
$6,241.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$7,578.60
|
| Rate for Payer: Global Benefits Group Commercial |
$5,349.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,661.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$823.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$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 |
$4,208.34
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,241.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,661.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,260.44
|
| 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 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 |
$8,240.00 |
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$6,986.15
|
| Rate for Payer: Adventist Health Commercial |
$1,643.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,698.55
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,753.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4,931.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,219.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,972.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,575.20
|
| 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 |
$4,208.34
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,753.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,219.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,849.21
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,727.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,984.27
|
| 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 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 |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,350.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$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 |
$6,312.51
|
| 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 |
$4,727.10
|
| 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 |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| 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 |
$5,402.40
|
| 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 |
$4,208.34
|
| 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 REPAIR HAND JOINT
|
Facility
|
IP
|
$6,753.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,727.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,984.27
|
| 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 HAND JOINT
|
Facility
|
OP
|
$6,753.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$2,768.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,279.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$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 |
$6,312.51
|
| 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 |
$4,727.10
|
| 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 |
$5,740.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,051.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,288.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,620.72
|
| 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 |
$5,402.40
|
| 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: TriValley Medical Group Commercial/Senior |
$4,051.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
