|
HC TREATMENT INITIAL 30 MIN
|
Facility
OP
|
$311.00
|
|
| Hospital Charge Code |
903204110
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$108.85 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.87
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$171.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$171.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$186.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: Cigna of CA HMO |
$199.04
|
| Rate for Payer: Cigna of CA PPO |
$230.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$233.25
|
| Rate for Payer: IEHP medi-cal |
$108.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.51
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: Riverside University Health MISP |
$124.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.35
|
| Rate for Payer: Vantage Medical Group Senior |
$264.35
|
|
|
HC TREATMENT INITIAL 30 MIN
|
Facility
IP
|
$311.00
|
|
| Hospital Charge Code |
903204110
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$279.90 |
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Central Health Plan Commercial |
$248.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.20
|
| Rate for Payer: Multiplan Commercial |
$233.25
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
|
|
HC TREATMENT INITIAL 30 MIN
|
Facility
IP
|
$269.00
|
|
| Hospital Charge Code |
905104314
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$242.10 |
| Rate for Payer: Cash Price |
$121.05
|
| Rate for Payer: Central Health Plan Commercial |
$215.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.60
|
| Rate for Payer: Galaxy Health WC |
$228.65
|
| Rate for Payer: Global Benefits Group Commercial |
$161.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$242.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$179.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.80
|
| Rate for Payer: Multiplan Commercial |
$201.75
|
| Rate for Payer: Networks By Design Commercial |
$174.85
|
| Rate for Payer: Prime Health Services Commercial |
$228.65
|
|
|
HC TREATMENT ROOM
|
Facility
OP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$386.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.74
|
| Rate for Payer: BCBS Transplant Transplant |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.56
|
| Rate for Payer: Blue Shield of California EPN |
$343.28
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$526.50
|
| Rate for Payer: IEHP medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: Riverside University Health MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TREATMENT ROOM
|
Facility
IP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC TREATMENT ROOM
|
Facility
OP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$386.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.74
|
| Rate for Payer: BCBS Transplant Transplant |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.56
|
| Rate for Payer: Blue Shield of California EPN |
$343.28
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$526.50
|
| Rate for Payer: IEHP medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: Riverside University Health MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC TREATMENT ROOM
|
Facility
IP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC TREAT PELVIC RING FX
|
Facility
IP
|
$726.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$653.40 |
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Central Health Plan Commercial |
$580.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$653.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Multiplan Commercial |
$544.50
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
|
|
HC TREAT PELVIC RING FX
|
Facility
OP
|
$726.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$435.60
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Central Health Plan Commercial |
$580.80
|
| Rate for Payer: Cigna of CA PPO |
$537.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$653.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$544.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$544.50
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$435.60
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other HMO |
$363.00
|
| Rate for Payer: United Healthcare HMO Rider |
$363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$363.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
IP
|
$1,799.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$1,619.10 |
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,439.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$719.60
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,619.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$1,349.25
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
OP
|
$1,799.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,079.40
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,439.20
|
| Rate for Payer: Cigna of CA PPO |
$1,331.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,619.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,349.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,349.25
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,079.40
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,079.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$899.50
|
| Rate for Payer: United Healthcare All Other HMO |
$899.50
|
| Rate for Payer: United Healthcare HMO Rider |
$899.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$899.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$244.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$732.00
|
| Rate for Payer: Blue Shield of California Commercial |
$767.38
|
| Rate for Payer: Blue Shield of California EPN |
$596.58
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Central Health Plan Commercial |
$976.00
|
| Rate for Payer: Cigna of CA HMO |
$780.80
|
| Rate for Payer: Cigna of CA PPO |
$902.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$915.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$732.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$244.00 |
| Max. Negotiated Rate |
$1,098.00 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Central Health Plan Commercial |
$976.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.00
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.00
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.00 |
| Max. Negotiated Rate |
$1,098.00 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Central Health Plan Commercial |
$976.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.00
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.00
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$732.00
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Central Health Plan Commercial |
$976.00
|
| Rate for Payer: Cigna of CA PPO |
$902.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,098.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$915.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$915.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$732.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.00
|
| Rate for Payer: United Healthcare All Other HMO |
$610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$610.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$964.80
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$964.80
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.00
|
| Rate for Payer: United Healthcare All Other HMO |
$804.00
|
| Rate for Payer: United Healthcare HMO Rider |
$804.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,447.20 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,447.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,206.00
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC TREAT TOE DISLOCATION W/ ANES
|
Facility
IP
|
$5,210.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
902890358
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,042.00 |
| Max. Negotiated Rate |
$4,689.00 |
| Rate for Payer: Cash Price |
$2,344.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,168.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,084.00
|
| Rate for Payer: Galaxy Health WC |
$4,428.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,689.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,475.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.00
|
| Rate for Payer: Multiplan Commercial |
$3,907.50
|
| Rate for Payer: Networks By Design Commercial |
$3,386.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,428.50
|
|
|
HC TREAT TOE DISLOCATION W/ ANES
|
Facility
OP
|
$5,210.00
|
|
|
Service Code
|
CPT 28665
|
| Hospital Charge Code |
902890358
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$335.55 |
| Max. Negotiated Rate |
$4,689.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$335.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,277.09
|
| Rate for Payer: Blue Shield of California EPN |
$2,547.69
|
| Rate for Payer: Caremore Medicare Advantage |
$335.55
|
| Rate for Payer: Cash Price |
$2,344.50
|
| Rate for Payer: Cash Price |
$2,344.50
|
| Rate for Payer: Cash Price |
$2,344.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,168.00
|
| Rate for Payer: Cigna of CA HMO |
$3,334.40
|
| Rate for Payer: Cigna of CA PPO |
$3,855.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$4,428.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,689.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,907.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$550.30
|
| Rate for Payer: IEHP medi-cal |
$553.66
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Innovage PACE Commercial |
$503.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,475.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,042.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$3,907.50
|
| Rate for Payer: Networks By Design Commercial |
$3,386.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,428.50
|
| Rate for Payer: Prime Health Services Medicare |
$355.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,126.00
|
| Rate for Payer: Riverside University Health MISP |
$369.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,605.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,605.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,605.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC TREAT WRIST BONE FX, W/O MANIP
|
Facility
OP
|
$2,446.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
900501374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,467.60
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.80
|
| Rate for Payer: Cigna of CA PPO |
$1,810.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$2,079.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,201.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,834.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,631.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,834.50
|
| Rate for Payer: Networks By Design Commercial |
$1,589.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.10
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,467.60
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,223.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,223.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,223.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,223.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT WRIST BONE FX, W/O MANIP
|
Facility
IP
|
$2,446.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
900501374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$489.20 |
| Max. Negotiated Rate |
$2,201.40 |
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,956.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.40
|
| Rate for Payer: Galaxy Health WC |
$2,079.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,201.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,631.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.20
|
| Rate for Payer: Multiplan Commercial |
$1,834.50
|
| Rate for Payer: Networks By Design Commercial |
$1,589.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.10
|
|
|
HC TRICHROME TEST
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900911728
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$371.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$76.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.81
|
| Rate for Payer: BCBS Transplant Transplant |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$51.91
|
| Rate for Payer: Blue Shield of California EPN |
$40.82
|
| Rate for Payer: Caremore Medicare Advantage |
$76.42
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$125.33
|
| Rate for Payer: IEHP medi-cal |
$126.09
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Innovage PACE Commercial |
$114.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$102.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Prime Health Services Medicare |
$81.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: Riverside University Health MISP |
$84.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC TRICHROME TEST
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900911728
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Central Health Plan Commercial |
$384.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.00
|
| Rate for Payer: Galaxy Health WC |
$408.00
|
| Rate for Payer: Global Benefits Group Commercial |
$288.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$312.00
|
| Rate for Payer: Prime Health Services Commercial |
$408.00
|
|
|
HC TRIGLYCERIDES
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900910234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$50.78 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.78
|
| Rate for Payer: BCBS Transplant Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$11.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.23
|
| Rate for Payer: Caremore Medicare Advantage |
$5.74
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Central Health Plan Commercial |
$15.20
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$14.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.41
|
| Rate for Payer: IEHP medi-cal |
$9.47
|
| Rate for Payer: IEHP Medicare Advantage |
$5.74
|
| Rate for Payer: Innovage PACE Commercial |
$8.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$14.25
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Prime Health Services Medicare |
$6.08
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: Riverside University Health MISP |
$6.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.65
|
| Rate for Payer: United Healthcare All Other HMO |
$4.65
|
| Rate for Payer: United Healthcare HMO Rider |
$4.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
|
HC TRIGLYCERIDES
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900910234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.80 |
| Max. Negotiated Rate |
$80.10 |
| Rate for Payer: Cash Price |
$40.05
|
| Rate for Payer: Central Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.60
|
| Rate for Payer: Galaxy Health WC |
$75.65
|
| Rate for Payer: Global Benefits Group Commercial |
$53.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$80.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$59.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.80
|
| Rate for Payer: Multiplan Commercial |
$66.75
|
| Rate for Payer: Networks By Design Commercial |
$57.85
|
| Rate for Payer: Prime Health Services Commercial |
$75.65
|
|
