|
HC OCCUP THERAPY EVAL - 60 MIN
|
Facility
|
IP
|
$540.00
|
|
| Hospital Charge Code |
905104002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$108.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
HC OCCUP THERAPY EVAL - 60 MIN
|
Facility
|
OP
|
$540.00
|
|
| Hospital Charge Code |
905104002
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$196.02 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$297.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.00
|
| 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 |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: Cigna of CA HMO |
$345.60
|
| Rate for Payer: Cigna of CA PPO |
$399.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$459.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$459.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$378.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: EPIC Health Plan Senior |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$342.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$318.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$378.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
| Rate for Payer: Riverside University Health System MISP |
$216.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$324.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$324.00
|
| 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 |
$459.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$459.00
|
| Rate for Payer: Vantage Medical Group Senior |
$459.00
|
|
|
HC OCCUP THER EVAL ADDL 15 MIN
|
Facility
|
OP
|
$162.00
|
|
| Hospital Charge Code |
905104021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$58.81 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| 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 |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Riverside University Health System MISP |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| 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 |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC OCCUP THER EVAL ADDL 15 MIN
|
Facility
|
IP
|
$162.00
|
|
| Hospital Charge Code |
905104021
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.80
|
| Rate for Payer: EPIC Health Plan Senior |
$26.80
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
|
|
HC OCTAPLAS STUDY
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT P9023
|
| Hospital Charge Code |
900904772
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$676.00 |
| Rate for Payer: Adventist Health Commercial |
$13.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$70.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.97
|
| Rate for Payer: Blue Shield of California Commercial |
$42.48
|
| Rate for Payer: Blue Shield of California EPN |
$26.73
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Central Health Plan Commercial |
$53.60
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$105.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.24
|
| Rate for Payer: EPIC Health Plan Senior |
$77.50
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$115.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$70.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$98.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.40
|
| Rate for Payer: Multiplan Commercial |
$50.25
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$70.45
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Prime Health Services Medicare |
$74.68
|
| Rate for Payer: Riverside University Health System MISP |
$77.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$70.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$105.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.50
|
| Rate for Payer: Vantage Medical Group Senior |
$70.45
|
|
|
HC OFFICE CONSULTATION/WHEELCHAIR
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
905103950
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$112.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.50
|
| 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 |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Senior |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Riverside University Health System MISP |
$109.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| 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 |
$232.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.90
|
| Rate for Payer: Vantage Medical Group Senior |
$232.90
|
|
|
HC OFFICE CONSULTATION/WHEELCHAIR
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 99241
|
| Hospital Charge Code |
905103950
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Senior |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.09 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.22
|
| Rate for Payer: Blue Shield of California Commercial |
$262.25
|
| Rate for Payer: Blue Shield of California EPN |
$164.81
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Central Health Plan Commercial |
$261.60
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$294.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Riverside University Health System MISP |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Blue Shield of California Commercial |
$262.25
|
| Rate for Payer: Blue Shield of California EPN |
$164.81
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Central Health Plan Commercial |
$261.60
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$294.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.40
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
915352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$107.09 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.22
|
| Rate for Payer: Blue Shield of California Commercial |
$262.25
|
| Rate for Payer: Blue Shield of California EPN |
$164.81
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Central Health Plan Commercial |
$261.60
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$294.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$162.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Riverside University Health System MISP |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Blue Shield of California Commercial |
$262.25
|
| Rate for Payer: Blue Shield of California EPN |
$164.81
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Central Health Plan Commercial |
$261.60
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$228.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$294.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$207.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$192.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.40
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.72
|
| Rate for Payer: United Healthcare All Other HMO |
$119.45
|
| Rate for Payer: United Healthcare HMO Rider |
$116.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.09
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Adventist Health Commercial |
$78.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.10
|
| Rate for Payer: Blue Shield of California Commercial |
$153.18
|
| Rate for Payer: Blue Shield of California EPN |
$96.26
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$162.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133.70
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Riverside University Health System MISP |
$76.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.35
|
| Rate for Payer: Vantage Medical Group Senior |
$162.35
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
915352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$153.18
|
| Rate for Payer: Blue Shield of California EPN |
$96.26
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.20
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
915352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Adventist Health Commercial |
$78.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.10
|
| Rate for Payer: Blue Shield of California Commercial |
$153.18
|
| Rate for Payer: Blue Shield of California EPN |
$96.26
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$162.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$117.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$133.70
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Riverside University Health System MISP |
$76.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.35
|
| Rate for Payer: Vantage Medical Group Senior |
$162.35
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Adventist Health Commercial |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$153.18
|
| Rate for Payer: Blue Shield of California EPN |
$96.26
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Senior |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.20
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$124.15
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.68
|
| Rate for Payer: United Healthcare All Other HMO |
$69.77
|
| Rate for Payer: United Healthcare HMO Rider |
$68.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.55
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
OP
|
$25.50
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.83
|
| Rate for Payer: Blue Shield of California Commercial |
$16.17
|
| Rate for Payer: Blue Shield of California EPN |
$10.17
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$16.32
|
| Rate for Payer: Cigna of CA PPO |
$18.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.57
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Riverside University Health System MISP |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
IP
|
$25.50
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Adventist Health Commercial |
$5.10
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.57
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
IP
|
$16,864.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,372.80 |
| Max. Negotiated Rate |
$15,177.60 |
| Rate for Payer: Adventist Health Commercial |
$3,372.80
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,491.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,804.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,745.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,745.60
|
| Rate for Payer: Galaxy Health WC |
$14,334.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10,118.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,177.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,708.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,949.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,372.80
|
| Rate for Payer: Multiplan Commercial |
$12,648.00
|
| Rate for Payer: Networks By Design Commercial |
$10,961.60
|
| Rate for Payer: Prime Health Services Commercial |
$14,334.40
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
OP
|
$16,864.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$3,372.80
|
| 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 |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Cash Price |
$7,588.80
|
| Rate for Payer: Central Health Plan Commercial |
$13,491.20
|
| Rate for Payer: Cigna of CA HMO |
$10,792.96
|
| Rate for Payer: Cigna of CA PPO |
$12,479.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,804.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$14,334.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10,118.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,177.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,708.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,372.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$12,648.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$10,961.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$14,334.40
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,118.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,432.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,432.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,432.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,432.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$34,467.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$6,893.40 |
| Max. Negotiated Rate |
$31,020.30 |
| Rate for Payer: Adventist Health Commercial |
$6,893.40
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Central Health Plan Commercial |
$27,573.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,786.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,786.80
|
| Rate for Payer: Galaxy Health WC |
$29,296.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,680.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,020.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,886.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,335.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,893.40
|
| Rate for Payer: Multiplan Commercial |
$25,850.25
|
| Rate for Payer: Networks By Design Commercial |
$22,403.55
|
| Rate for Payer: Prime Health Services Commercial |
$29,296.95
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$34,467.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$31,020.30 |
| Rate for Payer: Adventist Health Commercial |
$6,893.40
|
| 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 |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Cash Price |
$15,510.15
|
| Rate for Payer: Central Health Plan Commercial |
$27,573.60
|
| Rate for Payer: Cigna of CA HMO |
$22,058.88
|
| Rate for Payer: Cigna of CA PPO |
$25,505.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24,126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$29,296.95
|
| Rate for Payer: Global Benefits Group Commercial |
$20,680.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$31,020.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,886.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,893.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$25,850.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$22,403.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$29,296.95
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,680.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,233.50
|
| Rate for Payer: United Healthcare All Other HMO |
$17,233.50
|
| Rate for Payer: United Healthcare HMO Rider |
$17,233.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,233.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
IP
|
$23,129.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,625.80 |
| Max. Negotiated Rate |
$20,816.10 |
| Rate for Payer: Adventist Health Commercial |
$4,625.80
|
| Rate for Payer: Cash Price |
$10,408.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,503.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,190.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,251.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,251.60
|
| Rate for Payer: Galaxy Health WC |
$19,659.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,877.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,816.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,686.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,646.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,625.80
|
| Rate for Payer: Multiplan Commercial |
$17,346.75
|
| Rate for Payer: Networks By Design Commercial |
$15,033.85
|
| Rate for Payer: Prime Health Services Commercial |
$19,659.65
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
OP
|
$23,129.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$20,816.10 |
| Rate for Payer: Adventist Health Commercial |
$4,625.80
|
| 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 |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$10,408.05
|
| Rate for Payer: Cash Price |
$10,408.05
|
| Rate for Payer: Cash Price |
$10,408.05
|
| Rate for Payer: Cash Price |
$10,408.05
|
| Rate for Payer: Central Health Plan Commercial |
$18,503.20
|
| Rate for Payer: Cigna of CA HMO |
$14,802.56
|
| Rate for Payer: Cigna of CA PPO |
$17,115.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,190.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$19,659.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,877.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,816.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,686.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,625.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$17,346.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$15,033.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$19,659.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,877.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,564.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11,564.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11,564.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,564.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$3,053.20
|
| 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 |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$6,869.70
|
| Rate for Payer: Cash Price |
$6,869.70
|
| Rate for Payer: Cash Price |
$6,869.70
|
| Rate for Payer: Cash Price |
$6,869.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,212.80
|
| Rate for Payer: Cigna of CA HMO |
$9,770.24
|
| Rate for Payer: Cigna of CA PPO |
$11,296.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,686.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$12,976.10
|
| Rate for Payer: Global Benefits Group Commercial |
$9,159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,739.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,693.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$11,449.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$9,922.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
