|
HC FUSION OF TENDONS AT WRIST
|
Facility
OP
|
$9,884.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,895.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,930.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,907.20
|
| Rate for Payer: Cigna of CA PPO |
$7,314.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$8,401.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,930.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,895.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,413.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,592.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,976.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$7,413.00
|
| Rate for Payer: Networks By Design Commercial |
$6,424.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,401.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,930.40
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,930.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,942.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,942.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,942.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
IP
|
$9,884.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,976.80 |
| Max. Negotiated Rate |
$8,895.60 |
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Central Health Plan Commercial |
$7,907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,953.60
|
| Rate for Payer: Galaxy Health WC |
$8,401.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,930.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,895.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,592.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,976.80
|
| Rate for Payer: Multiplan Commercial |
$7,413.00
|
| Rate for Payer: Networks By Design Commercial |
$6,424.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,401.40
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
IP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$433.80 |
| Max. Negotiated Rate |
$1,952.10 |
| Rate for Payer: Blue Shield of California EPN |
$1,158.25
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.80
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
|
|
HC FX ORTHOSIS MOLDED AFO
|
Facility
OP
|
$2,169.00
|
|
|
Service Code
|
CPT L2108
|
| Hospital Charge Code |
905352108
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$759.15 |
| Max. Negotiated Rate |
$4,435.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,435.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,843.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,192.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,192.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,050.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,281.45
|
| Rate for Payer: BCBS Transplant Transplant |
$1,301.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,626.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,179.94
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Cash Price |
$976.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,735.20
|
| Rate for Payer: Cigna of CA HMO |
$1,518.30
|
| Rate for Payer: Cigna of CA PPO |
$1,518.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,843.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$867.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$867.60
|
| Rate for Payer: Galaxy Health WC |
$1,843.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,301.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,952.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,626.75
|
| Rate for Payer: IEHP medi-cal |
$759.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,446.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.29
|
| Rate for Payer: Multiplan Commercial |
$1,626.75
|
| Rate for Payer: Networks By Design Commercial |
$1,084.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,843.65
|
| Rate for Payer: Riverside University Health MISP |
$867.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,301.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,301.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,084.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,084.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,084.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,084.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,843.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,843.65
|
|
|
HC FX OX ADD SOCK
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$132.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$132.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.90
|
| Rate for Payer: BCBS Transplant Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$65.28
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$90.00
|
| Rate for Payer: IEHP medi-cal |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC FX OX ADD SOCK
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT L3995
|
| Hospital Charge Code |
905353995
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
905352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Blue Shield of California EPN |
$121.22
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
|
|
HC FX OX ADJ MOTION KNEE JT
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
CPT L2186
|
| Hospital Charge Code |
905352186
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$624.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$624.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$192.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$124.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$124.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.11
|
| Rate for Payer: BCBS Transplant Transplant |
$136.20
|
| Rate for Payer: Blue Shield of California Commercial |
$170.25
|
| Rate for Payer: Blue Shield of California EPN |
$123.49
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$158.90
|
| Rate for Payer: Cigna of CA PPO |
$158.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$170.25
|
| Rate for Payer: IEHP medi-cal |
$79.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.07
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$113.50
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Riverside University Health MISP |
$90.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.50
|
| Rate for Payer: United Healthcare All Other HMO |
$113.50
|
| Rate for Payer: United Healthcare HMO Rider |
$113.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.95
|
| Rate for Payer: Vantage Medical Group Senior |
$192.95
|
|
|
HC FX OX DROP LOCK
|
Facility
OP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
905352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$183.75 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$380.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$288.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$254.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.17
|
| Rate for Payer: BCBS Transplant Transplant |
$315.00
|
| Rate for Payer: Blue Shield of California Commercial |
$393.75
|
| Rate for Payer: Blue Shield of California EPN |
$285.60
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$393.75
|
| Rate for Payer: IEHP medi-cal |
$183.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.25
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Riverside University Health MISP |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO |
$262.50
|
| Rate for Payer: United Healthcare HMO Rider |
$262.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC FX OX DROP LOCK
|
Facility
IP
|
$525.00
|
|
|
Service Code
|
CPT L2182
|
| Hospital Charge Code |
905352182
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Blue Shield of California EPN |
$280.35
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$367.50
|
| Rate for Payer: Cigna of CA PPO |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$350.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$262.50
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
OP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
905352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$272.65 |
| Max. Negotiated Rate |
$1,480.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,480.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$662.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$428.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$428.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$377.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$460.23
|
| Rate for Payer: BCBS Transplant Transplant |
$467.40
|
| Rate for Payer: Blue Shield of California Commercial |
$584.25
|
| Rate for Payer: Blue Shield of California EPN |
$423.78
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Central Health Plan Commercial |
$623.20
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$662.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$701.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$584.25
|
| Rate for Payer: IEHP medi-cal |
$272.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$319.39
|
| Rate for Payer: Multiplan Commercial |
$584.25
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
| Rate for Payer: Riverside University Health MISP |
$311.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$467.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$467.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.50
|
| Rate for Payer: United Healthcare All Other HMO |
$389.50
|
| Rate for Payer: United Healthcare HMO Rider |
$389.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$389.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$662.15
|
| Rate for Payer: Vantage Medical Group Senior |
$662.15
|
|
|
HC FX OX HIP JT PELVIC BAND
|
Facility
IP
|
$779.00
|
|
|
Service Code
|
CPT L2192
|
| Hospital Charge Code |
905352192
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.80 |
| Max. Negotiated Rate |
$701.10 |
| Rate for Payer: Blue Shield of California EPN |
$415.99
|
| Rate for Payer: Cash Price |
$350.55
|
| Rate for Payer: Central Health Plan Commercial |
$623.20
|
| Rate for Payer: Cigna of CA HMO |
$545.30
|
| Rate for Payer: Cigna of CA PPO |
$545.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$311.60
|
| Rate for Payer: Galaxy Health WC |
$662.15
|
| Rate for Payer: Global Benefits Group Commercial |
$467.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$701.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$519.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.80
|
| Rate for Payer: Multiplan Commercial |
$584.25
|
| Rate for Payer: Networks By Design Commercial |
$389.50
|
| Rate for Payer: Prime Health Services Commercial |
$662.15
|
|
|
HC FX OX HUMERAL
|
Facility
OP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$385.00 |
| Max. Negotiated Rate |
$1,255.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,255.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$935.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$605.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$605.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$532.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$649.88
|
| Rate for Payer: BCBS Transplant Transplant |
$660.00
|
| Rate for Payer: Blue Shield of California Commercial |
$825.00
|
| Rate for Payer: Blue Shield of California EPN |
$598.40
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Central Health Plan Commercial |
$880.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$935.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$825.00
|
| Rate for Payer: IEHP medi-cal |
$385.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.00
|
| Rate for Payer: Multiplan Commercial |
$825.00
|
| Rate for Payer: Networks By Design Commercial |
$550.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
| Rate for Payer: Riverside University Health MISP |
$440.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$660.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$660.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.00
|
| Rate for Payer: United Healthcare All Other HMO |
$550.00
|
| Rate for Payer: United Healthcare HMO Rider |
$550.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$550.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.00
|
| Rate for Payer: Vantage Medical Group Senior |
$935.00
|
|
|
HC FX OX HUMERAL
|
Facility
IP
|
$1,100.00
|
|
|
Service Code
|
CPT L3980
|
| Hospital Charge Code |
905353980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$220.00 |
| Max. Negotiated Rate |
$990.00 |
| Rate for Payer: Blue Shield of California EPN |
$587.40
|
| Rate for Payer: Cash Price |
$495.00
|
| Rate for Payer: Central Health Plan Commercial |
$880.00
|
| Rate for Payer: Cigna of CA HMO |
$770.00
|
| Rate for Payer: Cigna of CA PPO |
$770.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$440.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$440.00
|
| Rate for Payer: Galaxy Health WC |
$935.00
|
| Rate for Payer: Global Benefits Group Commercial |
$660.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$990.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$733.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.00
|
| Rate for Payer: Multiplan Commercial |
$825.00
|
| Rate for Payer: Networks By Design Commercial |
$550.00
|
| Rate for Payer: Prime Health Services Commercial |
$935.00
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
905352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Blue Shield of California EPN |
$299.04
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.00
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC FX OX LIMIT MOTION KNEE JT
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT L2184
|
| Hospital Charge Code |
905352184
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$514.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$514.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$271.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.85
|
| Rate for Payer: BCBS Transplant Transplant |
$336.00
|
| Rate for Payer: Blue Shield of California Commercial |
$420.00
|
| Rate for Payer: Blue Shield of California EPN |
$304.64
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Central Health Plan Commercial |
$448.00
|
| Rate for Payer: Cigna of CA HMO |
$392.00
|
| Rate for Payer: Cigna of CA PPO |
$392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$420.00
|
| Rate for Payer: IEHP medi-cal |
$196.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Networks By Design Commercial |
$280.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Riverside University Health MISP |
$224.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$280.00
|
| Rate for Payer: United Healthcare All Other HMO |
$280.00
|
| Rate for Payer: United Healthcare HMO Rider |
$280.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$280.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC FX OX QUAD BRIM
|
Facility
OP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$316.75 |
| Max. Negotiated Rate |
$1,243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$769.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$497.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$497.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$438.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.67
|
| Rate for Payer: BCBS Transplant Transplant |
$543.00
|
| Rate for Payer: Blue Shield of California Commercial |
$678.75
|
| Rate for Payer: Blue Shield of California EPN |
$492.32
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$769.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$678.75
|
| Rate for Payer: IEHP medi-cal |
$316.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.05
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
| Rate for Payer: Riverside University Health MISP |
$362.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$452.50
|
| Rate for Payer: United Healthcare All Other HMO |
$452.50
|
| Rate for Payer: United Healthcare HMO Rider |
$452.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$452.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$769.25
|
| Rate for Payer: Vantage Medical Group Senior |
$769.25
|
|
|
HC FX OX QUAD BRIM
|
Facility
IP
|
$905.00
|
|
|
Service Code
|
CPT L2188
|
| Hospital Charge Code |
905352188
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$181.00 |
| Max. Negotiated Rate |
$814.50 |
| Rate for Payer: Blue Shield of California EPN |
$483.27
|
| Rate for Payer: Cash Price |
$407.25
|
| Rate for Payer: Central Health Plan Commercial |
$724.00
|
| Rate for Payer: Cigna of CA HMO |
$633.50
|
| Rate for Payer: Cigna of CA PPO |
$633.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$362.00
|
| Rate for Payer: Galaxy Health WC |
$769.25
|
| Rate for Payer: Global Benefits Group Commercial |
$543.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$814.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$603.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.00
|
| Rate for Payer: Multiplan Commercial |
$678.75
|
| Rate for Payer: Networks By Design Commercial |
$452.50
|
| Rate for Payer: Prime Health Services Commercial |
$769.25
|
|
|
HC FX OX SHOE INSERT
|
Facility
IP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
905352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Blue Shield of California EPN |
$118.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
|
|
HC FX OX SHOE INSERT
|
Facility
OP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
905352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.70 |
| Max. Negotiated Rate |
$486.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$486.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$122.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.16
|
| Rate for Payer: BCBS Transplant Transplant |
$133.20
|
| Rate for Payer: Blue Shield of California Commercial |
$166.50
|
| Rate for Payer: Blue Shield of California EPN |
$120.77
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$166.50
|
| Rate for Payer: IEHP medi-cal |
$77.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.02
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Riverside University Health MISP |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC FX OX WAIST BELT
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Blue Shield of California EPN |
$70.49
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC FX OX WAIST BELT
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$362.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$362.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.99
|
| Rate for Payer: BCBS Transplant Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$99.00
|
| Rate for Payer: Blue Shield of California EPN |
$71.81
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$99.00
|
| Rate for Payer: IEHP medi-cal |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FX OX WRIST
|
Facility
OP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$253.40 |
| Max. Negotiated Rate |
$1,398.33 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,398.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$398.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$398.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$350.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$427.74
|
| Rate for Payer: BCBS Transplant Transplant |
$434.40
|
| Rate for Payer: Blue Shield of California Commercial |
$543.00
|
| Rate for Payer: Blue Shield of California EPN |
$393.86
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$615.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$543.00
|
| Rate for Payer: IEHP medi-cal |
$253.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.84
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$362.00
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Riverside University Health MISP |
$289.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$362.00
|
| Rate for Payer: United Healthcare All Other HMO |
$362.00
|
| Rate for Payer: United Healthcare HMO Rider |
$362.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$362.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$615.40
|
| Rate for Payer: Vantage Medical Group Senior |
$615.40
|
|
|
HC FX OX WRIST
|
Facility
IP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Blue Shield of California EPN |
$386.62
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.80
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$362.00
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
IP
|
$347.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Blue Shield of California Commercial |
$260.25
|
| Rate for Payer: Blue Shield of California EPN |
$185.30
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
