|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$3,053.20
|
| Rate for Payer: Cash Price |
$6,869.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,212.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,686.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,106.40
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,693.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,006.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.20
|
| Rate for Payer: Multiplan Commercial |
$11,449.50
|
| Rate for Payer: Networks By Design Commercial |
$9,922.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.10
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,053.20 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$3,053.20
|
| Rate for Payer: Cash Price |
$6,869.70
|
| Rate for Payer: Central Health Plan Commercial |
$12,212.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,686.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,106.40
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,693.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,006.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,053.20
|
| Rate for Payer: Multiplan Commercial |
$11,449.50
|
| Rate for Payer: Networks By Design Commercial |
$9,922.90
|
| Rate for Payer: Prime Health Services Commercial |
$12,976.10
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$15,266.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,739.40 |
| Rate for Payer: Adventist Health Commercial |
$6,259.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,766.22
|
| 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: TriValley Medical Group Commercial/Senior |
$9,159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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/TOE FRACTURE
|
Facility
|
IP
|
$19,476.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,895.20 |
| Max. Negotiated Rate |
$17,528.40 |
| Rate for Payer: Adventist Health Commercial |
$3,895.20
|
| Rate for Payer: Cash Price |
$8,764.20
|
| Rate for Payer: Central Health Plan Commercial |
$15,580.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,633.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,790.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,790.40
|
| Rate for Payer: Galaxy Health WC |
$16,554.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,685.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,528.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,367.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,490.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,895.20
|
| Rate for Payer: Multiplan Commercial |
$14,607.00
|
| Rate for Payer: Networks By Design Commercial |
$12,659.40
|
| Rate for Payer: Prime Health Services Commercial |
$16,554.60
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
OP
|
$19,476.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$17,528.40 |
| Rate for Payer: Adventist Health Commercial |
$3,895.20
|
| 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 |
$8,764.20
|
| Rate for Payer: Cash Price |
$8,764.20
|
| Rate for Payer: Cash Price |
$8,764.20
|
| Rate for Payer: Cash Price |
$8,764.20
|
| Rate for Payer: Central Health Plan Commercial |
$15,580.80
|
| Rate for Payer: Cigna of CA HMO |
$12,464.64
|
| Rate for Payer: Cigna of CA PPO |
$14,412.24
|
| 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 |
$13,633.20
|
| 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 |
$16,554.60
|
| Rate for Payer: Global Benefits Group Commercial |
$11,685.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,528.40
|
| 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 |
$12,367.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$428.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,895.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$14,607.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$12,659.40
|
| 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 |
$16,554.60
|
| 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 |
$11,685.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,738.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,738.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,738.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,738.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$7,403.37
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,008.58
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: Cigna of CA HMO |
$11,556.48
|
| Rate for Payer: Cigna of CA PPO |
$13,362.18
|
| 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 |
$12,639.90
|
| 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 |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| 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 |
$11,466.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| 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 |
$15,348.45
|
| 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 |
$10,834.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,834.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,611.40 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$3,611.40
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,639.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,222.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,222.80
|
| Rate for Payer: Galaxy Health WC |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,466.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,653.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,348.45
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$3,611.40
|
| 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 |
$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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: Cigna of CA HMO |
$11,556.48
|
| Rate for Payer: Cigna of CA PPO |
$13,362.18
|
| 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 |
$12,639.90
|
| 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 |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| 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 |
$11,466.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| 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 |
$15,348.45
|
| 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 |
$10,834.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,028.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,028.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9,028.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,028.50
|
| 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 INTERPHALANGEAL DIS
|
Facility
|
IP
|
$18,057.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,611.40 |
| Max. Negotiated Rate |
$16,251.30 |
| Rate for Payer: Adventist Health Commercial |
$3,611.40
|
| Rate for Payer: Cash Price |
$8,125.65
|
| Rate for Payer: Central Health Plan Commercial |
$14,445.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,639.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,222.80
|
| Rate for Payer: EPIC Health Plan Senior |
$7,222.80
|
| Rate for Payer: Galaxy Health WC |
$15,348.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10,834.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,251.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,466.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,653.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,611.40
|
| Rate for Payer: Multiplan Commercial |
$13,542.75
|
| Rate for Payer: Networks By Design Commercial |
$11,737.05
|
| Rate for Payer: Prime Health Services Commercial |
$15,348.45
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
OP
|
$14,851.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$13,365.90 |
| Rate for Payer: Adventist Health Commercial |
$2,970.20
|
| 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 |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,976.10
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,880.80
|
| Rate for Payer: Cigna of CA HMO |
$9,504.64
|
| Rate for Payer: Cigna of CA PPO |
$10,989.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,395.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| Rate for Payer: Galaxy Health WC |
$12,623.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,910.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,365.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,430.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,184.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,970.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan Commercial |
$11,138.25
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$9,653.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Commercial |
$12,623.35
|
| Rate for Payer: Prime Health Services Medicare |
$8,070.72
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,375.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,910.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,425.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
IP
|
$14,851.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,970.20 |
| Max. Negotiated Rate |
$13,365.90 |
| Rate for Payer: Adventist Health Commercial |
$2,970.20
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Central Health Plan Commercial |
$11,880.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,395.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,940.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,940.40
|
| Rate for Payer: Galaxy Health WC |
$12,623.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,910.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,365.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,430.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,762.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,970.20
|
| Rate for Payer: Multiplan Commercial |
$11,138.25
|
| Rate for Payer: Networks By Design Commercial |
$9,653.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,623.35
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
IP
|
$16,022.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,204.40 |
| Max. Negotiated Rate |
$14,419.80 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,817.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,408.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,408.80
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,419.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,452.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,204.40
|
| Rate for Payer: Multiplan Commercial |
$12,016.50
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| Rate for Payer: Prime Health Services Commercial |
$13,618.70
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
OP
|
$16,022.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$14,419.80 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| 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 |
$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 |
$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 |
$6,568.63
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Central Health Plan Commercial |
$12,817.60
|
| Rate for Payer: Cigna of CA HMO |
$10,254.08
|
| Rate for Payer: Cigna of CA PPO |
$11,856.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,215.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$13,618.70
|
| Rate for Payer: Global Benefits Group Commercial |
$9,613.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,419.80
|
| 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 |
$10,173.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,204.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$12,016.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$10,414.30
|
| 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 |
$13,618.70
|
| 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 |
$9,613.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,011.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,011.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,011.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,011.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
OP
|
$20,200.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$18,180.00 |
| Rate for Payer: Adventist Health Commercial |
$4,040.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$9,090.00
|
| Rate for Payer: Cash Price |
$9,090.00
|
| Rate for Payer: Cash Price |
$9,090.00
|
| Rate for Payer: Cash Price |
$9,090.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,160.00
|
| Rate for Payer: Cigna of CA HMO |
$12,928.00
|
| Rate for Payer: Cigna of CA PPO |
$14,948.00
|
| 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 |
$14,140.00
|
| 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 |
$17,170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,180.00
|
| 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 |
$12,827.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,040.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$15,150.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$13,130.00
|
| 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 |
$17,170.00
|
| 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 |
$12,120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10,100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,100.00
|
| 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 METATARSAL FX, EA
|
Facility
|
IP
|
$20,200.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,040.00 |
| Max. Negotiated Rate |
$18,180.00 |
| Rate for Payer: Adventist Health Commercial |
$4,040.00
|
| Rate for Payer: Cash Price |
$9,090.00
|
| Rate for Payer: Central Health Plan Commercial |
$16,160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,080.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,080.00
|
| Rate for Payer: Galaxy Health WC |
$17,170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,827.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,918.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,040.00
|
| Rate for Payer: Multiplan Commercial |
$15,150.00
|
| Rate for Payer: Networks By Design Commercial |
$13,130.00
|
| Rate for Payer: Prime Health Services Commercial |
$17,170.00
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
OP
|
$13,490.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$2,698.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$6,070.50
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,792.00
|
| Rate for Payer: Cigna of CA HMO |
$8,633.60
|
| Rate for Payer: Cigna of CA PPO |
$9,982.60
|
| 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 |
$9,443.00
|
| 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 |
$11,466.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,094.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,141.00
|
| 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 |
$8,566.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,698.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$10,117.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$8,768.50
|
| 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 |
$11,466.50
|
| 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 |
$8,094.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,745.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,745.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,745.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,745.00
|
| 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 TALUS FRACTURE
|
Facility
|
IP
|
$13,490.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,698.00 |
| Max. Negotiated Rate |
$12,141.00 |
| Rate for Payer: Adventist Health Commercial |
$2,698.00
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,792.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,443.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,396.00
|
| Rate for Payer: Galaxy Health WC |
$11,466.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,094.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,141.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,566.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,959.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,698.00
|
| Rate for Payer: Multiplan Commercial |
$10,117.50
|
| Rate for Payer: Networks By Design Commercial |
$8,768.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,466.50
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.03 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| 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 |
$931.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$822.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$931.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$931.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$931.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$767.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$646.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$767.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Riverside University Health System MISP |
$438.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$931.60
|
| Rate for Payer: Vantage Medical Group Senior |
$931.60
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
OP
|
$1,366.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$1,229.40 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$286.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$661.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$794.60
|
| Rate for Payer: Blue Shield of California Commercial |
$860.58
|
| Rate for Payer: Blue Shield of California EPN |
$542.30
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,092.80
|
| Rate for Payer: Cigna of CA HMO |
$874.24
|
| Rate for Payer: Cigna of CA PPO |
$1,010.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$1,161.10
|
| Rate for Payer: Global Benefits Group Commercial |
$819.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,229.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$867.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$1,024.50
|
| Rate for Payer: Networks By Design Commercial |
$887.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.10
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$819.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$819.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
IP
|
$1,366.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.20 |
| Max. Negotiated Rate |
$1,229.40 |
| Rate for Payer: Adventist Health Commercial |
$273.20
|
| Rate for Payer: Cash Price |
$614.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,092.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.40
|
| Rate for Payer: EPIC Health Plan Senior |
$546.40
|
| Rate for Payer: Galaxy Health WC |
$1,161.10
|
| Rate for Payer: Global Benefits Group Commercial |
$819.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,229.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$867.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$805.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.20
|
| Rate for Payer: Multiplan Commercial |
$1,024.50
|
| Rate for Payer: Networks By Design Commercial |
$887.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.10
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.01
|
| Rate for Payer: Blue Shield of California Commercial |
$289.80
|
| Rate for Payer: Blue Shield of California EPN |
$182.62
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$322.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$292.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$271.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Riverside University Health System MISP |
$184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.44 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Adventist Health Commercial |
$175.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$744.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$657.00
|
| Rate for Payer: Blue Shield of California Commercial |
$551.88
|
| Rate for Payer: Blue Shield of California EPN |
$347.77
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Central Health Plan Commercial |
$700.80
|
| Rate for Payer: Cigna of CA HMO |
$560.64
|
| Rate for Payer: Cigna of CA PPO |
$648.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$744.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$744.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$744.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$613.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.40
|
| Rate for Payer: EPIC Health Plan Senior |
$350.40
|
| Rate for Payer: Galaxy Health WC |
$744.60
|
| Rate for Payer: Global Benefits Group Commercial |
$525.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$788.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$556.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$613.20
|
| Rate for Payer: Multiplan Commercial |
$657.00
|
| Rate for Payer: Networks By Design Commercial |
$569.40
|
| Rate for Payer: Prime Health Services Commercial |
$744.60
|
| Rate for Payer: Riverside University Health System MISP |
$350.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$438.00
|
| Rate for Payer: United Healthcare All Other HMO |
$438.00
|
| Rate for Payer: United Healthcare HMO Rider |
$438.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$744.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$744.60
|
| Rate for Payer: Vantage Medical Group Senior |
$744.60
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Adventist Health Commercial |
$175.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Central Health Plan Commercial |
$700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$613.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.40
|
| Rate for Payer: EPIC Health Plan Senior |
$350.40
|
| Rate for Payer: Galaxy Health WC |
$744.60
|
| Rate for Payer: Global Benefits Group Commercial |
$525.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$788.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$556.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$516.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$657.00
|
| Rate for Payer: Networks By Design Commercial |
$569.40
|
| Rate for Payer: Prime Health Services Commercial |
$744.60
|
|
