|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$365.20 |
| Max. Negotiated Rate |
$1,552.10 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,278.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Senior |
$730.40
|
| Rate for Payer: Galaxy Health WC |
$1,552.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,159.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,077.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.24
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: Networks By Design Commercial |
$1,186.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.10
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$1,826.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$365.20 |
| Max. Negotiated Rate |
$1,552.10 |
| Rate for Payer: Adventist Health Commercial |
$365.20
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,278.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.40
|
| Rate for Payer: EPIC Health Plan Senior |
$730.40
|
| Rate for Payer: Galaxy Health WC |
$1,552.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,159.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,077.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.24
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: Networks By Design Commercial |
$1,186.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.10
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$730.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,085.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna of CA HMO |
$1,140.48
|
| Rate for Payer: Cigna of CA PPO |
$1,318.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,247.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,069.20
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$356.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna of CA HMO |
$1,140.48
|
| Rate for Payer: Cigna of CA PPO |
$1,318.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,247.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$891.00
|
| Rate for Payer: United Healthcare All Other HMO |
$891.00
|
| Rate for Payer: United Healthcare HMO Rider |
$891.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$891.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$356.40
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,247.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: EPIC Health Plan Senior |
$712.80
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,051.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$356.40
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,247.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: EPIC Health Plan Senior |
$712.80
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,131.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,051.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
OP
|
$2,582.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$516.40 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$516.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,161.90
|
| Rate for Payer: Cash Price |
$1,161.90
|
| Rate for Payer: Cash Price |
$1,161.90
|
| Rate for Payer: Cigna of CA HMO |
$1,652.48
|
| Rate for Payer: Cigna of CA PPO |
$1,910.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,807.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,194.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,639.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,065.60
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,678.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,194.70
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,549.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,291.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,291.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,291.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,291.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
IP
|
$2,582.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$516.40 |
| Max. Negotiated Rate |
$2,194.70 |
| Rate for Payer: Adventist Health Commercial |
$516.40
|
| Rate for Payer: Cash Price |
$1,161.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,807.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,032.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,032.80
|
| Rate for Payer: Galaxy Health WC |
$2,194.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,639.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,523.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.68
|
| Rate for Payer: Multiplan Commercial |
$2,065.60
|
| Rate for Payer: Networks By Design Commercial |
$1,678.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,194.70
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,429.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cigna of CA HMO |
$1,219.84
|
| Rate for Payer: Cigna of CA PPO |
$1,410.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,334.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,210.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,124.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,334.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,334.20
|
| Rate for Payer: Multiplan Commercial |
$1,524.80
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,143.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$953.00
|
| Rate for Payer: United Healthcare All Other HMO |
$953.00
|
| Rate for Payer: United Healthcare HMO Rider |
$953.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$953.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.10
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$1,620.10 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,334.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,210.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,124.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.44
|
| Rate for Payer: Multiplan Commercial |
$1,524.80
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cigna of CA HMO |
$1,219.84
|
| Rate for Payer: Cigna of CA PPO |
$1,410.44
|
| Rate for Payer: Adventist Health Commercial |
$781.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,429.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,334.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,210.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,124.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,334.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,334.20
|
| Rate for Payer: Multiplan Commercial |
$1,524.80
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,143.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,143.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.10
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,906.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$1,620.10 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,334.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,210.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,124.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.44
|
| Rate for Payer: Multiplan Commercial |
$1,524.80
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
OP
|
$1,635.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$899.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,226.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Cigna of CA HMO |
$1,046.40
|
| Rate for Payer: Cigna of CA PPO |
$1,209.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,389.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,389.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,144.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,144.50
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$981.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.50
|
| Rate for Payer: United Healthcare All Other HMO |
$817.50
|
| Rate for Payer: United Healthcare HMO Rider |
$817.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,389.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,389.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,389.75
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
IP
|
$1,635.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.00 |
| Max. Negotiated Rate |
$1,389.75 |
| Rate for Payer: Adventist Health Commercial |
$327.00
|
| Rate for Payer: Cash Price |
$735.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$654.00
|
| Rate for Payer: EPIC Health Plan Senior |
$654.00
|
| Rate for Payer: Galaxy Health WC |
$1,389.75
|
| Rate for Payer: Global Benefits Group Commercial |
$981.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,038.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Multiplan Commercial |
$1,308.00
|
| Rate for Payer: Networks By Design Commercial |
$1,062.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,389.75
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
OP
|
$1,958.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,076.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,468.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO |
$1,253.12
|
| Rate for Payer: Cigna of CA PPO |
$1,448.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,664.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,664.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$95.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,370.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,370.60
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,174.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$979.00
|
| Rate for Payer: United Healthcare All Other HMO |
$979.00
|
| Rate for Payer: United Healthcare HMO Rider |
$979.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$979.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,664.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,664.30
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
IP
|
$1,958.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.60 |
| Max. Negotiated Rate |
$1,664.30 |
| Rate for Payer: Adventist Health Commercial |
$391.60
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,370.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Senior |
$783.20
|
| Rate for Payer: Galaxy Health WC |
$1,664.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,174.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,243.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,155.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.92
|
| Rate for Payer: Multiplan Commercial |
$1,566.40
|
| Rate for Payer: Networks By Design Commercial |
$1,272.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,664.30
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
IP
|
$6,877.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,375.40 |
| Max. Negotiated Rate |
$5,845.45 |
| Rate for Payer: Adventist Health Commercial |
$1,375.40
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,813.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,750.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,750.80
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,366.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,057.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
OP
|
$6,877.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$567.30 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,375.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cash Price |
$3,094.65
|
| Rate for Payer: Cigna of CA HMO |
$4,401.28
|
| Rate for Payer: Cigna of CA PPO |
$5,088.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,813.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$5,845.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,126.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,366.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,650.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$5,501.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,470.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,845.45
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,126.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,438.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,438.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,438.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,438.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$9,968.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,993.60 |
| Max. Negotiated Rate |
$8,472.80 |
| Rate for Payer: Adventist Health Commercial |
$1,993.60
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,987.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,987.20
|
| Rate for Payer: Galaxy Health WC |
$8,472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,980.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,329.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,881.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.32
|
| Rate for Payer: Multiplan Commercial |
$7,974.40
|
| Rate for Payer: Networks By Design Commercial |
$6,479.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,472.80
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$9,968.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$4,086.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,792.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Cigna of CA HMO |
$6,379.52
|
| Rate for Payer: Cigna of CA PPO |
$7,376.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$8,472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,980.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,329.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$7,974.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$6,479.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,472.80
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,980.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,980.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$9,968.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$556.70 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,993.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Cigna of CA HMO |
$6,379.52
|
| Rate for Payer: Cigna of CA PPO |
$7,376.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$8,472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,980.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,329.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$7,974.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$6,479.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,472.80
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,980.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,984.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,984.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,984.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$9,968.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,993.60 |
| Max. Negotiated Rate |
$8,472.80 |
| Rate for Payer: Adventist Health Commercial |
$1,993.60
|
| Rate for Payer: Cash Price |
$4,485.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,977.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,987.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,987.20
|
| Rate for Payer: Galaxy Health WC |
$8,472.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,980.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,329.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,881.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.32
|
| Rate for Payer: Multiplan Commercial |
$7,974.40
|
| Rate for Payer: Networks By Design Commercial |
$6,479.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,472.80
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$1,488.35 |
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,225.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$700.40
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,111.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,033.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.24
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,488.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$963.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,313.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Cash Price |
$787.95
|
| Rate for Payer: Cigna of CA HMO |
$1,120.64
|
| Rate for Payer: Cigna of CA PPO |
$1,295.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,488.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,488.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,488.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,225.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$700.40
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,111.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,033.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$420.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,225.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,225.70
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,050.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$875.50
|
| Rate for Payer: United Healthcare All Other HMO |
$875.50
|
| Rate for Payer: United Healthcare HMO Rider |
$875.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$875.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,488.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,488.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,488.35
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
OP
|
$11,046.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$12,964.88 |
| Rate for Payer: Adventist Health Commercial |
$2,209.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,393.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: Cash Price |
$4,970.70
|
| Rate for Payer: Cigna of CA HMO |
$7,069.44
|
| Rate for Payer: Cigna of CA PPO |
$8,174.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,833.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,393.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,732.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,249.67
|
| Rate for Payer: EPIC Health Plan Senior |
$4,833.11
|
| Rate for Payer: Galaxy Health WC |
$9,389.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,627.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,205.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,014.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,723.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,651.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,536.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,887.61
|
| Rate for Payer: Multiplan Commercial |
$8,836.80
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$7,179.90
|
| Rate for Payer: Prime Health Services Commercial |
$9,389.10
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,523.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,523.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,523.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,523.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,393.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,590.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,833.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4,393.74
|
|
