|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,471.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,777.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,297.66
|
| 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 |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$2,134.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| 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 |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,471.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| 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/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,777.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,950.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,561.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,802.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,170.69
|
| 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 |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
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 |
$11,292.75 |
| Rate for Payer: Adventist Health Commercial |
$2,118.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,844.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| 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 |
$10,266.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,528.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,844.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,413.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,292.75
|
| Rate for Payer: EPIC Health Plan Senior |
$7,528.50
|
| 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/Senior |
$11,224.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,844.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,724.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,609.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,357.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,541.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,623.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,171.08
|
| 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 |
$6,844.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,844.09
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,413.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,724.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,248.10
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,826.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,564.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,382.42
|
| 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 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 |
$8,240.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
| Rate for Payer: Adventist Health Commercial |
$807.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| 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 |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,826.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| 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/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,564.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| 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 |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$849.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,974.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| 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/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,698.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,019.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| 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 |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,974.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,698.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,506.91
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$440.14
|
| 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
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
OP
|
$746.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.15 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cigna of CA HMO |
$477.44
|
| Rate for Payer: Cigna of CA PPO |
$552.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$596.80
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$373.00
|
| Rate for Payer: United Healthcare All Other HMO |
$373.00
|
| Rate for Payer: United Healthcare HMO Rider |
$373.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
OP
|
$4,742.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$948.40 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: United Healthcare HMO Rider |
$2,371.00
|
| Rate for Payer: Adventist Health Commercial |
$948.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$2,133.90
|
| Rate for Payer: Cash Price |
$2,133.90
|
| Rate for Payer: Cash Price |
$2,133.90
|
| Rate for Payer: Cigna of CA HMO |
$3,034.88
|
| Rate for Payer: Cigna of CA PPO |
$3,509.08
|
| 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 |
$3,319.40
|
| 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 |
$4,030.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,845.20
|
| 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 |
$3,011.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,138.08
|
| 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 |
$3,793.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$3,082.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,030.70
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,845.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,371.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,371.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,371.00
|
| 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 MUSCLES OF HAND, EA
|
Facility
|
IP
|
$4,742.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$948.40 |
| Max. Negotiated Rate |
$4,030.70 |
| Rate for Payer: Adventist Health Commercial |
$948.40
|
| Rate for Payer: Cash Price |
$2,133.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,319.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,896.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,896.80
|
| Rate for Payer: Galaxy Health WC |
$4,030.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,845.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,011.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,797.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,138.08
|
| Rate for Payer: Multiplan Commercial |
$3,793.60
|
| Rate for Payer: Networks By Design Commercial |
$3,082.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,030.70
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
OP
|
$5,577.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.50 |
| Max. Negotiated Rate |
$11,292.75 |
| Rate for Payer: Adventist Health Commercial |
$1,115.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,844.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$2,509.65
|
| Rate for Payer: Cash Price |
$2,509.65
|
| Rate for Payer: Cash Price |
$2,509.65
|
| Rate for Payer: Cigna of CA HMO |
$3,569.28
|
| Rate for Payer: Cigna of CA PPO |
$4,126.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,528.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,844.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,903.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,292.75
|
| Rate for Payer: EPIC Health Plan Senior |
$7,528.50
|
| Rate for Payer: Galaxy Health WC |
$4,740.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,346.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,224.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,844.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,541.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,357.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,623.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,171.08
|
| Rate for Payer: Multiplan Commercial |
$4,461.60
|
| Rate for Payer: Multiplan WC |
$10,445.70
|
| Rate for Payer: Networks By Design Commercial |
$3,625.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,740.45
|
| Rate for Payer: Prime Health Services WC |
$10,339.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,346.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,788.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,788.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,788.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,788.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,844.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,844.09
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
IP
|
$5,577.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,115.40 |
| Max. Negotiated Rate |
$4,740.45 |
| Rate for Payer: EPIC Health Plan Commercial |
$2,230.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,230.80
|
| Rate for Payer: Galaxy Health WC |
$4,740.45
|
| Rate for Payer: Adventist Health Commercial |
$1,115.40
|
| Rate for Payer: Cash Price |
$2,509.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,903.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,346.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,541.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,290.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,338.48
|
| Rate for Payer: Multiplan Commercial |
$4,461.60
|
| Rate for Payer: Networks By Design Commercial |
$3,625.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,740.45
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$5,345.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,069.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cigna of CA HMO |
$3,420.80
|
| Rate for Payer: Cigna of CA PPO |
$3,955.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,741.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,852.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,672.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,672.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,672.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,672.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$4,543.25 |
| Rate for Payer: Adventist Health Commercial |
$1,069.00
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,741.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,138.00
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,153.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$5,345.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cigna of CA HMO |
$3,420.80
|
| Rate for Payer: Cigna of CA PPO |
$3,955.30
|
| Rate for Payer: Adventist Health Commercial |
$2,191.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$840.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,741.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,852.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,207.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,207.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$5,345.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,069.00 |
| Max. Negotiated Rate |
$4,543.25 |
| Rate for Payer: Adventist Health Commercial |
$1,069.00
|
| Rate for Payer: Cash Price |
$2,405.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,741.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,138.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,138.00
|
| Rate for Payer: Galaxy Health WC |
$4,543.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,394.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,153.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.80
|
| Rate for Payer: Multiplan Commercial |
$4,276.00
|
| Rate for Payer: Networks By Design Commercial |
$3,474.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,543.25
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
OP
|
$3,269.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$340.25 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$653.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,778.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,797.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,451.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$1,471.05
|
| Rate for Payer: Cash Price |
$1,471.05
|
| Rate for Payer: Cash Price |
$1,471.05
|
| Rate for Payer: Cigna of CA HMO |
$2,092.16
|
| Rate for Payer: Cigna of CA PPO |
$2,419.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,778.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,778.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,778.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,288.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,307.60
|
| Rate for Payer: Galaxy Health WC |
$2,778.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,961.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,075.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,928.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,288.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,288.30
|
| Rate for Payer: Multiplan Commercial |
$2,615.20
|
| Rate for Payer: Networks By Design Commercial |
$2,124.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,778.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,961.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,634.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,778.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,778.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,778.65
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
IP
|
$3,269.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$653.80 |
| Max. Negotiated Rate |
$2,778.65 |
| Rate for Payer: Adventist Health Commercial |
$653.80
|
| Rate for Payer: Cash Price |
$1,471.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,288.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,307.60
|
| Rate for Payer: Galaxy Health WC |
$2,778.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,961.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,075.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,928.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.56
|
| Rate for Payer: Multiplan Commercial |
$2,615.20
|
| Rate for Payer: Networks By Design Commercial |
$2,124.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,778.65
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$8,841.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,768.20 |
| Max. Negotiated Rate |
$7,514.85 |
| Rate for Payer: Adventist Health Commercial |
$1,768.20
|
| Rate for Payer: Cash Price |
$3,978.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,536.40
|
| Rate for Payer: Galaxy Health WC |
$7,514.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,304.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,614.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,216.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,121.84
|
| Rate for Payer: Multiplan Commercial |
$7,072.80
|
| Rate for Payer: Networks By Design Commercial |
$5,746.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,514.85
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$8,841.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$1,768.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,978.45
|
| Rate for Payer: Cash Price |
$3,978.45
|
| Rate for Payer: Cash Price |
$3,978.45
|
| Rate for Payer: Cigna of CA HMO |
$5,658.24
|
| Rate for Payer: Cigna of CA PPO |
$6,542.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$7,514.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,304.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,614.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,121.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$7,072.80
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$5,746.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,514.85
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,304.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,420.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,420.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,420.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,420.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
905354205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO |
$107.10
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$55.89
|
| Rate for Payer: United Healthcare HMO Rider |
$54.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.11
|
|
|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
915354205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO |
$107.10
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$55.89
|
| Rate for Payer: United Healthcare HMO Rider |
$54.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.11
|
|
|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
915354205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$62.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.61
|
| Rate for Payer: Blue Shield of California Commercial |
$77.57
|
| Rate for Payer: Blue Shield of California Commercial |
$117.66
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cigna of CA HMO |
$107.10
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$55.89
|
| Rate for Payer: United Healthcare HMO Rider |
$54.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.05
|
| Rate for Payer: Vantage Medical Group Senior |
$130.05
|
|
