|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
IP
|
$11,311.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,262.20 |
| Max. Negotiated Rate |
$9,614.35 |
| Rate for Payer: Adventist Health Commercial |
$2,262.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,734.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8,698.16
|
| Rate for Payer: Cash Price |
$5,089.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,917.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,524.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,524.40
|
| Rate for Payer: Galaxy Health WC |
$9,614.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,786.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,182.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,673.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,714.64
|
| Rate for Payer: Multiplan Commercial |
$9,048.80
|
| Rate for Payer: Networks By Design Commercial |
$7,352.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,614.35
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
OP
|
$5,567.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,113.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,968.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,505.15
|
| Rate for Payer: Cash Price |
$2,505.15
|
| Rate for Payer: Cash Price |
$2,505.15
|
| Rate for Payer: Cigna of CA HMO |
$3,562.88
|
| Rate for Payer: Cigna of CA PPO |
$4,119.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,265.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,968.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,896.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,897.61
|
| Rate for Payer: EPIC Health Plan Senior |
$3,265.07
|
| Rate for Payer: Galaxy Health WC |
$4,731.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,340.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,867.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,968.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,535.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,768.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,190.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,739.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,977.45
|
| Rate for Payer: Multiplan Commercial |
$4,453.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,618.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,731.95
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,340.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,783.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,783.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,783.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,968.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,452.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,265.07
|
| Rate for Payer: Vantage Medical Group Senior |
$2,968.25
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
IP
|
$5,567.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,113.40 |
| Max. Negotiated Rate |
$4,731.95 |
| Rate for Payer: EPIC Health Plan Commercial |
$2,226.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,226.80
|
| Rate for Payer: Galaxy Health WC |
$4,731.95
|
| Rate for Payer: Adventist Health Commercial |
$1,113.40
|
| Rate for Payer: Cash Price |
$2,505.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,896.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,340.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,535.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,284.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.08
|
| Rate for Payer: Multiplan Commercial |
$4,453.60
|
| Rate for Payer: Networks By Design Commercial |
$3,618.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,731.95
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
IP
|
$4,462.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$892.40 |
| Max. Negotiated Rate |
$3,792.70 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,123.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.80
|
| Rate for Payer: Galaxy Health WC |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,833.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.88
|
| Rate for Payer: Multiplan Commercial |
$3,569.60
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$713.03 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cash Price |
$2,007.90
|
| Rate for Payer: Cigna of CA HMO |
$2,855.68
|
| Rate for Payer: Cigna of CA PPO |
$3,301.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,123.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,833.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$713.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$3,569.60
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,677.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,231.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,231.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,231.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$436.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$436.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.53
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.34
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Multiplan WC |
$607.16
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: Prime Health Services WC |
$600.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.00
|
| Rate for Payer: United Healthcare All Other HMO |
$370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Vantage Medical Group Senior |
$395.03
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.53
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.80
|
| Rate for Payer: EPIC Health Plan Senior |
$434.53
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.34
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Multiplan WC |
$607.16
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: Prime Health Services WC |
$600.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.00
|
| 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 |
$395.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.53
|
| Rate for Payer: Vantage Medical Group Senior |
$395.03
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cigna of CA HMO |
$634.88
|
| Rate for Payer: Cigna of CA PPO |
$734.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$694.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$629.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$496.00
|
| Rate for Payer: United Healthcare All Other HMO |
$496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$496.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$843.20 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$694.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.80
|
| Rate for Payer: EPIC Health Plan Senior |
$396.80
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$629.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$585.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$4,257.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$851.40 |
| Max. Negotiated Rate |
$3,618.45 |
| Rate for Payer: Adventist Health Commercial |
$851.40
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,979.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,702.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,702.80
|
| Rate for Payer: Galaxy Health WC |
$3,618.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,703.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,511.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.68
|
| Rate for Payer: Multiplan Commercial |
$3,405.60
|
| Rate for Payer: Networks By Design Commercial |
$2,767.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,618.45
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$4,257.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$851.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Cigna of CA HMO |
$2,724.48
|
| Rate for Payer: Cigna of CA PPO |
$3,150.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,979.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$3,618.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,703.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$3,405.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,767.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,618.45
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,554.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,128.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,128.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,128.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,128.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$4,257.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,745.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,098.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Cigna of CA HMO |
$2,724.48
|
| Rate for Payer: Cigna of CA PPO |
$3,150.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,979.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$3,618.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,703.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$145.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$3,405.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,767.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,618.45
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,554.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,554.20
|
| 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 |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$4,257.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$851.40 |
| Max. Negotiated Rate |
$3,618.45 |
| Rate for Payer: Adventist Health Commercial |
$851.40
|
| Rate for Payer: Cash Price |
$1,915.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,979.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,702.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,702.80
|
| Rate for Payer: Galaxy Health WC |
$3,618.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,703.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,511.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.68
|
| Rate for Payer: Multiplan Commercial |
$3,405.60
|
| Rate for Payer: Networks By Design Commercial |
$2,767.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,618.45
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.40 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$925.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: EPIC Health Plan Senior |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$839.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$779.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$264.40 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$925.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: EPIC Health Plan Senior |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$839.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$779.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$925.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$839.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$661.00
|
| Rate for Payer: United Healthcare All Other HMO |
$661.00
|
| Rate for Payer: United Healthcare HMO Rider |
$661.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$661.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Adventist Health Commercial |
$542.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$965.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$925.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$839.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$793.20
|
| 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 |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$7,972.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$3,268.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,245.71
|
| 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 |
$3,587.40
|
| Rate for Payer: Cash Price |
$3,587.40
|
| Rate for Payer: Cash Price |
$3,587.40
|
| Rate for Payer: Cigna of CA HMO |
$5,102.08
|
| Rate for Payer: Cigna of CA PPO |
$5,899.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,580.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$6,776.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.20
|
| 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 |
$5,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,377.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,181.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,776.20
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,783.20
|
| 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 |
$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 REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$7,972.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,594.40 |
| Max. Negotiated Rate |
$6,776.20 |
| Rate for Payer: Adventist Health Commercial |
$1,594.40
|
| Rate for Payer: Cash Price |
$3,587.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,580.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.80
|
| Rate for Payer: Galaxy Health WC |
$6,776.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,703.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.28
|
| Rate for Payer: Multiplan Commercial |
$6,377.60
|
| Rate for Payer: Networks By Design Commercial |
$5,181.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,776.20
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$7,972.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Galaxy Health WC |
$6,776.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.20
|
| 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 |
$5,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$710.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,377.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,181.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,776.20
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,986.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,986.00
|
| 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
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Adventist Health Commercial |
$1,594.40
|
| 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 |
$3,587.40
|
| Rate for Payer: Cash Price |
$3,587.40
|
| Rate for Payer: Cash Price |
$3,587.40
|
| Rate for Payer: Cigna of CA HMO |
$5,102.08
|
| Rate for Payer: Cigna of CA PPO |
$5,899.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,580.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$7,972.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,594.40 |
| Max. Negotiated Rate |
$6,776.20 |
| Rate for Payer: Adventist Health Commercial |
$1,594.40
|
| Rate for Payer: Cash Price |
$3,587.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,580.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.80
|
| Rate for Payer: Galaxy Health WC |
$6,776.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,062.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,703.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.28
|
| Rate for Payer: Multiplan Commercial |
$6,377.60
|
| Rate for Payer: Networks By Design Commercial |
$5,181.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,776.20
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.05
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$168.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
