|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
905354205
|
|
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
|
|
|
HC REPAIR ORTHOTIC DEVICE PARTS
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT L4210
|
| Hospital Charge Code |
905354210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
|
|
HC REPAIR ORTHOTIC DEVICE PARTS
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L4210
|
| Hospital Charge Code |
905354210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.88 |
| Max. Negotiated Rate |
$286.45 |
| Rate for Payer: Adventist Health Commercial |
$138.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.99
|
| Rate for Payer: Blue Shield of California Commercial |
$170.86
|
| Rate for Payer: Blue Shield of California Commercial |
$259.15
|
| Rate for Payer: Cash Price |
$151.65
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$214.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.90
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$13,914.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,782.80 |
| Max. Negotiated Rate |
$11,826.90 |
| Rate for Payer: Adventist Health Commercial |
$2,782.80
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,565.60
|
| Rate for Payer: Galaxy Health WC |
$11,826.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,348.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,835.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,209.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,339.36
|
| Rate for Payer: Multiplan Commercial |
$11,131.20
|
| Rate for Payer: Networks By Design Commercial |
$9,044.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,826.90
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$13,914.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.33 |
| Max. Negotiated Rate |
$12,562.92 |
| Rate for Payer: Adventist Health Commercial |
$2,782.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Cigna of CA HMO |
$8,904.96
|
| Rate for Payer: Cigna of CA PPO |
$10,296.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Galaxy Health WC |
$11,826.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,348.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,835.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,184.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,339.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| Rate for Payer: Multiplan Commercial |
$11,131.20
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$9,044.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,826.90
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,348.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,957.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,957.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,957.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,957.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$13,914.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$405.33 |
| Max. Negotiated Rate |
$12,562.92 |
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
| Rate for Payer: Adventist Health Commercial |
$5,704.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,733.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Cigna of CA HMO |
$8,904.96
|
| Rate for Payer: Cigna of CA PPO |
$10,296.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Galaxy Health WC |
$11,826.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,348.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,835.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,184.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,339.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| Rate for Payer: Multiplan Commercial |
$11,131.20
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$9,044.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,826.90
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,348.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,348.40
|
| 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 |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$13,914.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,782.80 |
| Max. Negotiated Rate |
$11,826.90 |
| Rate for Payer: Adventist Health Commercial |
$2,782.80
|
| Rate for Payer: Cash Price |
$6,261.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,565.60
|
| Rate for Payer: Galaxy Health WC |
$11,826.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,348.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,835.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,209.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,339.36
|
| Rate for Payer: Multiplan Commercial |
$11,131.20
|
| Rate for Payer: Networks By Design Commercial |
$9,044.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,826.90
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$10,820.50 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,510.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Networks By Design Commercial |
$8,274.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
IP
|
$12,730.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,546.00 |
| Max. Negotiated Rate |
$10,820.50 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,911.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,092.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,092.00
|
| Rate for Payer: Galaxy Health WC |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,510.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Networks By Design Commercial |
$8,274.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$10,820.50 |
| Rate for Payer: Adventist Health Commercial |
$2,546.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cigna of CA HMO |
$8,147.20
|
| Rate for Payer: Cigna of CA PPO |
$9,420.20
|
| 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 |
$8,911.00
|
| 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 |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,274.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,365.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,365.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,365.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,365.00
|
| 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 PROFUNDUS TENDON
|
Facility
|
OP
|
$12,730.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$10,820.50 |
| Rate for Payer: Adventist Health Commercial |
$5,219.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,995.71
|
| 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 |
$5,728.50
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cash Price |
$5,728.50
|
| Rate for Payer: Cigna of CA HMO |
$8,147.20
|
| Rate for Payer: Cigna of CA PPO |
$9,420.20
|
| 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 |
$8,911.00
|
| 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 |
$10,820.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,638.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,083.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,055.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$10,184.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,274.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,820.50
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,638.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,638.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR PROS DEVICE PER 15MIN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905367520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
|
|
HC REPAIR PROS DEVICE PER 15MIN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905367520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.32 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Adventist Health Commercial |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.90
|
| Rate for Payer: Blue Shield of California Commercial |
$9.13
|
| Rate for Payer: Blue Shield of California Commercial |
$13.84
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$324.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$171.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| 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 |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$6,574.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,314.80 |
| Max. Negotiated Rate |
$5,587.90 |
| Rate for Payer: Adventist Health Commercial |
$1,314.80
|
| Rate for Payer: Cash Price |
$2,958.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,601.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,629.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,629.60
|
| Rate for Payer: Galaxy Health WC |
$5,587.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,944.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,174.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,878.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.76
|
| Rate for Payer: Multiplan Commercial |
$5,259.20
|
| Rate for Payer: Networks By Design Commercial |
$4,273.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,587.90
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$6,574.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,314.80 |
| Max. Negotiated Rate |
$5,587.90 |
| Rate for Payer: Adventist Health Commercial |
$1,314.80
|
| Rate for Payer: Cash Price |
$2,958.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,601.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,629.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,629.60
|
| Rate for Payer: Galaxy Health WC |
$5,587.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,944.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,174.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,878.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.76
|
| Rate for Payer: Multiplan Commercial |
$5,259.20
|
| Rate for Payer: Networks By Design Commercial |
$4,273.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,587.90
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$6,574.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$2,695.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,999.04
|
| 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 |
$2,958.30
|
| Rate for Payer: Cash Price |
$2,958.30
|
| Rate for Payer: Cash Price |
$2,958.30
|
| Rate for Payer: Cigna of CA HMO |
$4,207.36
|
| Rate for Payer: Cigna of CA PPO |
$4,864.76
|
| 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 |
$4,601.80
|
| 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 |
$5,587.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,944.40
|
| 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 |
$4,174.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.76
|
| 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 |
$5,259.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,273.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,587.90
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,944.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,944.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$6,574.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,314.80
|
| 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 |
$2,958.30
|
| Rate for Payer: Cash Price |
$2,958.30
|
| Rate for Payer: Cash Price |
$2,958.30
|
| Rate for Payer: Cigna of CA HMO |
$4,207.36
|
| Rate for Payer: Cigna of CA PPO |
$4,864.76
|
| 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 |
$4,601.80
|
| 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 |
$5,587.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,944.40
|
| 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 |
$4,174.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,577.76
|
| 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 |
$5,259.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,273.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,587.90
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,944.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,287.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,287.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,287.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,287.00
|
| 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 TENDON,LEG PRIM W/O GRF
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$548.21 |
| Max. Negotiated Rate |
$6,943.76 |
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cigna of CA HMO |
$4,455.04
|
| Rate for Payer: Cigna of CA PPO |
$5,151.14
|
| 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 |
$4,872.70
|
| 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 |
$5,916.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| 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 |
$4,420.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$548.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| 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 |
$5,568.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,480.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,480.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,480.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,480.50
|
| 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 TENDON,LEG PRIM W/O GRF
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,392.20 |
| Max. Negotiated Rate |
$5,916.85 |
| Rate for Payer: Galaxy Health WC |
$5,916.85
|
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,529.23
|
| Rate for Payer: Blue Shield of California Commercial |
$5,353.01
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,872.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,784.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,420.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,106.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Multiplan Commercial |
$5,568.80
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
|
|
HC REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
OP
|
$9,167.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.78 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,833.40
|
| 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 |
$9,104.00
|
| Rate for Payer: Cash Price |
$4,125.15
|
| Rate for Payer: Cash Price |
$4,125.15
|
| Rate for Payer: Cash Price |
$4,125.15
|
| Rate for Payer: Cigna of CA HMO |
$5,866.88
|
| Rate for Payer: Cigna of CA PPO |
$6,783.58
|
| 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 |
$6,416.90
|
| 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 |
$7,791.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,500.20
|
| 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 |
$5,821.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.08
|
| 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 |
$7,333.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,958.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,791.95
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,500.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,583.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,583.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,583.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,583.50
|
| 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 TENDON/MUSCLE PRIM SNGL
|
Facility
|
IP
|
$9,167.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,833.40 |
| Max. Negotiated Rate |
$7,791.95 |
| Rate for Payer: Adventist Health Commercial |
$1,833.40
|
| Rate for Payer: Cash Price |
$4,125.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,416.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,666.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,666.80
|
| Rate for Payer: Galaxy Health WC |
$7,791.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,500.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,821.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,408.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,200.08
|
| Rate for Payer: Multiplan Commercial |
$7,333.60
|
| Rate for Payer: Networks By Design Commercial |
$5,958.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,791.95
|
|
