|
HC TREATMENT EA ADDL 15 MIN
|
Facility
|
IP
|
$172.00
|
|
| Hospital Charge Code |
903204112
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC TREATMENT INITIAL 30 MIN
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
905104314
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$199.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC TREATMENT INITIAL 30 MIN
|
Facility
|
IP
|
$330.00
|
|
| Hospital Charge Code |
903204110
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$209.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
|
|
HC TREATMENT INITIAL 30 MIN
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
905104314
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$103.45 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$116.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$242.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$199.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$180.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$168.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Riverside University Health System MISP |
$114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC TREATMENT INITIAL 30 MIN
|
Facility
|
OP
|
$330.00
|
|
| Hospital Charge Code |
903204110
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$119.79 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$135.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$211.20
|
| Rate for Payer: Cigna of CA PPO |
$244.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$280.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$280.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$280.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$209.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$194.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Riverside University Health System MISP |
$132.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$280.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$280.50
|
| Rate for Payer: Vantage Medical Group Senior |
$280.50
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$591.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Senior |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$536.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$498.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$491.54
|
| Rate for Payer: Blue Shield of California Commercial |
$535.73
|
| Rate for Payer: Blue Shield of California EPN |
$337.15
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Cigna of CA HMO |
$540.80
|
| Rate for Payer: Cigna of CA PPO |
$625.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$591.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$536.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Other HMO |
$422.50
|
| Rate for Payer: United Healthcare HMO Rider |
$422.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$845.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$491.54
|
| Rate for Payer: Blue Shield of California Commercial |
$535.73
|
| Rate for Payer: Blue Shield of California EPN |
$337.15
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Cigna of CA HMO |
$540.80
|
| Rate for Payer: Cigna of CA PPO |
$625.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$591.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$536.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$306.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$507.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.50
|
| Rate for Payer: United Healthcare All Other HMO |
$422.50
|
| Rate for Payer: United Healthcare HMO Rider |
$422.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$422.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$845.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$760.50 |
| Rate for Payer: Adventist Health Commercial |
$169.00
|
| Rate for Payer: Cash Price |
$380.25
|
| Rate for Payer: Central Health Plan Commercial |
$676.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$591.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.00
|
| Rate for Payer: EPIC Health Plan Senior |
$338.00
|
| Rate for Payer: Galaxy Health WC |
$718.25
|
| Rate for Payer: Global Benefits Group Commercial |
$507.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$760.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$536.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$498.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.00
|
| Rate for Payer: Multiplan Commercial |
$633.75
|
| Rate for Payer: Networks By Design Commercial |
$549.25
|
| Rate for Payer: Prime Health Services Commercial |
$718.25
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
OP
|
$960.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: Cigna of CA HMO |
$614.40
|
| Rate for Payer: Cigna of CA PPO |
$710.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$609.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$576.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$480.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
IP
|
$960.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.00 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Adventist Health Commercial |
$192.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Central Health Plan Commercial |
$768.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Senior |
$384.00
|
| Rate for Payer: Galaxy Health WC |
$816.00
|
| Rate for Payer: Global Benefits Group Commercial |
$576.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$864.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$609.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$566.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$720.00
|
| Rate for Payer: Networks By Design Commercial |
$624.00
|
| Rate for Payer: Prime Health Services Commercial |
$816.00
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,375.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$786.00
|
| Rate for Payer: Galaxy Health WC |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,768.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$950.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Cigna of CA HMO |
$1,257.60
|
| Rate for Payer: Cigna of CA PPO |
$1,454.10
|
| 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 |
$1,375.50
|
| 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 |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,768.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$478.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$528.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,330.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,179.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$982.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| 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 TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Cigna of CA HMO |
$1,257.60
|
| Rate for Payer: Cigna of CA PPO |
$1,454.10
|
| 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 |
$1,375.50
|
| 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 |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,768.50
|
| 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 |
$1,247.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$528.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,179.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$982.50
|
| Rate for Payer: United Healthcare All Other HMO |
$982.50
|
| Rate for Payer: United Healthcare HMO Rider |
$982.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$982.50
|
| 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 TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,768.50 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Cash Price |
$884.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,572.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,375.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$786.00
|
| Rate for Payer: Galaxy Health WC |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,768.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.00
|
| Rate for Payer: Multiplan Commercial |
$1,473.75
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$322.60 |
| Max. Negotiated Rate |
$1,451.70 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.20
|
| Rate for Payer: EPIC Health Plan Senior |
$645.20
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$951.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$758.50
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,022.64
|
| Rate for Payer: Blue Shield of California EPN |
$643.59
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: Cigna of CA HMO |
$1,032.32
|
| Rate for Payer: Cigna of CA PPO |
$1,193.62
|
| 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 |
$1,129.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$967.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$967.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| 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 TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.10 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: Cigna of CA HMO |
$1,032.32
|
| Rate for Payer: Cigna of CA PPO |
$1,193.62
|
| 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 |
$1,129.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| 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 |
$1,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$967.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$806.50
|
| Rate for Payer: United Healthcare All Other HMO |
$806.50
|
| Rate for Payer: United Healthcare HMO Rider |
$806.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.50
|
| 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 TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$216.44 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: Cigna of CA HMO |
$1,032.32
|
| Rate for Payer: Cigna of CA PPO |
$1,193.62
|
| 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 |
$1,129.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$967.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$806.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| 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 TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$322.60 |
| Max. Negotiated Rate |
$1,451.70 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.20
|
| Rate for Payer: EPIC Health Plan Senior |
$645.20
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$951.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$322.60 |
| Max. Negotiated Rate |
$1,451.70 |
| Rate for Payer: Adventist Health Commercial |
$322.60
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,129.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.20
|
| Rate for Payer: EPIC Health Plan Senior |
$645.20
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,024.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$951.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$274.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC TREAT TOE DISLOCATION W/ ANES
|
Facility
|
OP
|
$6,891.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
902890358
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$6,201.90 |
| Rate for Payer: Adventist Health Commercial |
$2,825.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$758.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,512.80
|
| Rate for Payer: Cigna of CA HMO |
$4,410.24
|
| Rate for Payer: Cigna of CA PPO |
$5,099.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,823.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$5,857.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,134.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,201.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,375.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,378.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$5,168.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$4,479.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$5,857.35
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,134.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,134.60
|
| 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: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC TREAT TOE DISLOCATION W/ ANES
|
Facility
|
IP
|
$6,891.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
902890358
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,378.20 |
| Max. Negotiated Rate |
$6,201.90 |
| Rate for Payer: Adventist Health Commercial |
$1,378.20
|
| Rate for Payer: Cash Price |
$3,100.95
|
| Rate for Payer: Central Health Plan Commercial |
$5,512.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,823.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,756.40
|
| Rate for Payer: Galaxy Health WC |
$5,857.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,134.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,201.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,375.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,065.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,378.20
|
| Rate for Payer: Multiplan Commercial |
$5,168.25
|
| Rate for Payer: Networks By Design Commercial |
$4,479.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,857.35
|
|
