|
HC PART HAND REST W/GLOVE THMB
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
915356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Adventist Health Commercial |
$643.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,487.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,621.87
|
| Rate for Payer: Cash Price |
$1,769.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,574.40
|
| Rate for Payer: Cigna of CA HMO |
$2,252.60
|
| Rate for Payer: Cigna of CA PPO |
$2,252.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,896.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,991.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$643.60
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,207.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1,175.54
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,053.89
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,117.60 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$2,117.60
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,235.20
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,034.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,553.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$4,341.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: Cigna of CA HMO |
$6,776.32
|
| Rate for Payer: Cigna of CA PPO |
$7,835.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,352.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,352.80
|
| 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 |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
IP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,117.60 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$2,117.60
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,235.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,235.20
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,034.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,553.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
|
OP
|
$10,588.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$9,529.20 |
| Rate for Payer: Adventist Health Commercial |
$2,117.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Cash Price |
$5,823.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,470.40
|
| Rate for Payer: Cigna of CA HMO |
$6,776.32
|
| Rate for Payer: Cigna of CA PPO |
$7,835.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$8,999.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,352.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,062.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,117.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$7,941.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,882.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$8,999.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,352.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,294.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,294.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,294.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,294.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
905356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,997.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,954.51
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,490.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,477.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.60
|
| Rate for Payer: Multiplan Commercial |
$2,908.50
|
| Rate for Payer: Networks By Design Commercial |
$2,520.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
OP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
905356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.05 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Adventist Health Commercial |
$1,589.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,132.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,908.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,277.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,997.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,954.51
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,296.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,296.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,490.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,582.52
|
| Rate for Payer: InnovAge PACE Commercial |
$1,939.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.60
|
| Rate for Payer: Multiplan Commercial |
$2,908.50
|
| Rate for Payer: Networks By Design Commercial |
$1,939.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,551.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,326.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,326.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,296.30
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
IP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
915356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Adventist Health Commercial |
$775.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,997.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,954.51
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,490.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,477.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.60
|
| Rate for Payer: Multiplan Commercial |
$2,908.50
|
| Rate for Payer: Networks By Design Commercial |
$2,520.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
|
|
HC PARTIAL HAND NO FINGER REMAIN
|
Facility
|
OP
|
$3,878.00
|
|
|
Service Code
|
CPT L6020
|
| Hospital Charge Code |
915356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,270.05 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Adventist Health Commercial |
$1,589.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,132.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,908.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,277.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,997.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,954.51
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Cash Price |
$2,132.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,102.40
|
| Rate for Payer: Cigna of CA HMO |
$2,714.60
|
| Rate for Payer: Cigna of CA PPO |
$2,714.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,296.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,296.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,551.20
|
| Rate for Payer: Galaxy Health WC |
$3,296.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,326.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,490.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,582.52
|
| Rate for Payer: InnovAge PACE Commercial |
$1,939.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,748.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,400.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.60
|
| Rate for Payer: Multiplan Commercial |
$2,908.50
|
| Rate for Payer: Networks By Design Commercial |
$1,939.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,296.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,551.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,326.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,326.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,455.41
|
| Rate for Payer: United Healthcare All Other HMO |
$1,416.63
|
| Rate for Payer: United Healthcare HMO Rider |
$1,386.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,270.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,296.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,296.30
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
905356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.00 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Adventist Health Commercial |
$808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,122.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,036.16
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,232.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,636.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,539.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.00
|
| Rate for Payer: Multiplan Commercial |
$3,030.00
|
| Rate for Payer: Networks By Design Commercial |
$2,626.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
IP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
915356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$808.00 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Adventist Health Commercial |
$808.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,122.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,036.16
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,232.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,636.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,539.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.00
|
| Rate for Payer: Multiplan Commercial |
$3,030.00
|
| Rate for Payer: Networks By Design Commercial |
$2,626.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
915356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,323.10 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Adventist Health Commercial |
$1,656.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,222.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,030.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,372.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3,122.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,036.16
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,232.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,434.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,434.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,636.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,473.51
|
| Rate for Payer: InnovAge PACE Commercial |
$2,020.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,627.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,656.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,828.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,828.00
|
| Rate for Payer: Multiplan Commercial |
$3,030.00
|
| Rate for Payer: Networks By Design Commercial |
$2,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,616.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,424.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,424.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,434.00
|
|
|
HC PARTIAL HAND THUMB REMAINING
|
Facility
|
OP
|
$4,040.00
|
|
|
Service Code
|
CPT L6000
|
| Hospital Charge Code |
905356000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,323.10 |
| Max. Negotiated Rate |
$3,636.00 |
| Rate for Payer: Adventist Health Commercial |
$1,656.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,222.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,030.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,372.69
|
| Rate for Payer: Blue Shield of California Commercial |
$3,122.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,036.16
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Cash Price |
$2,222.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,232.00
|
| Rate for Payer: Cigna of CA HMO |
$2,828.00
|
| Rate for Payer: Cigna of CA PPO |
$2,828.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,434.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,434.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,616.00
|
| Rate for Payer: Galaxy Health WC |
$3,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,424.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,636.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,473.51
|
| Rate for Payer: InnovAge PACE Commercial |
$2,020.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,627.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,500.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,656.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,828.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,828.00
|
| Rate for Payer: Multiplan Commercial |
$3,030.00
|
| Rate for Payer: Networks By Design Commercial |
$2,020.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,434.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,616.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,424.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,424.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,516.21
|
| Rate for Payer: United Healthcare All Other HMO |
$1,475.81
|
| Rate for Payer: United Healthcare HMO Rider |
$1,443.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,323.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,434.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,434.00
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
|
IP
|
$10,697.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,139.40 |
| Max. Negotiated Rate |
$9,627.30 |
| Rate for Payer: Adventist Health Commercial |
$2,139.40
|
| Rate for Payer: Cash Price |
$5,883.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,557.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,278.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,278.80
|
| Rate for Payer: Galaxy Health WC |
$9,092.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,627.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,134.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,075.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,621.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.40
|
| Rate for Payer: Multiplan Commercial |
$8,022.75
|
| Rate for Payer: Networks By Design Commercial |
$6,953.05
|
| Rate for Payer: Prime Health Services Commercial |
$9,092.45
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
|
OP
|
$10,697.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,627.30 |
| Rate for Payer: Adventist Health Commercial |
$2,139.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$5,883.35
|
| Rate for Payer: Cash Price |
$5,883.35
|
| Rate for Payer: Cash Price |
$5,883.35
|
| Rate for Payer: Cash Price |
$5,883.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,557.60
|
| Rate for Payer: Cigna of CA HMO |
$6,846.08
|
| Rate for Payer: Cigna of CA PPO |
$7,915.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$9,092.45
|
| Rate for Payer: Global Benefits Group Commercial |
$6,418.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,627.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,134.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,139.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$8,022.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$6,953.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$9,092.45
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,418.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,348.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,348.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,348.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,348.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
|
OP
|
$12,215.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$10,993.50 |
| Rate for Payer: Adventist Health Commercial |
$2,443.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,617.28
|
| Rate for Payer: Cash Price |
$6,718.25
|
| Rate for Payer: Cash Price |
$6,718.25
|
| Rate for Payer: Cash Price |
$6,718.25
|
| Rate for Payer: Cash Price |
$6,718.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,772.00
|
| Rate for Payer: Cigna of CA HMO |
$7,817.60
|
| Rate for Payer: Cigna of CA PPO |
$9,039.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$10,382.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,329.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,993.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: InnovAge PACE Commercial |
$4,346.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,147.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,443.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,883.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$9,161.25
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$7,939.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Preferred Health Network WC |
$4,711.51
|
| Rate for Payer: Prime Health Services Commercial |
$10,382.75
|
| Rate for Payer: Prime Health Services Medicare |
$3,071.77
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,187.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,329.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,107.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,107.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,107.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,107.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC PARTIAL RMVL OF EYE FLUID
|
Facility
|
IP
|
$12,215.00
|
|
|
Service Code
|
CPT 67005
|
| Hospital Charge Code |
900501540
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,443.00 |
| Max. Negotiated Rate |
$10,993.50 |
| Rate for Payer: Adventist Health Commercial |
$2,443.00
|
| Rate for Payer: Cash Price |
$6,718.25
|
| Rate for Payer: Central Health Plan Commercial |
$9,772.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,886.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,886.00
|
| Rate for Payer: Galaxy Health WC |
$10,382.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,329.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,993.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,147.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,653.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,561.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,443.00
|
| Rate for Payer: Multiplan Commercial |
$9,161.25
|
| Rate for Payer: Networks By Design Commercial |
$7,939.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,382.75
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
OP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
905356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,126.50 |
| Max. Negotiated Rate |
$11,340.00 |
| Rate for Payer: Adventist Health Commercial |
$5,166.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,930.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,399.98
|
| Rate for Payer: Blue Shield of California Commercial |
$9,739.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,350.40
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,080.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,710.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,340.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,820.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,820.00
|
| Rate for Payer: Multiplan Commercial |
$9,450.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,040.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,560.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,560.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,710.00
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
IP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
905356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$11,340.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,739.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,350.40
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,080.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,520.00
|
| Rate for Payer: Multiplan Commercial |
$9,450.00
|
| Rate for Payer: Networks By Design Commercial |
$8,190.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
OP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
915356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,126.50 |
| Max. Negotiated Rate |
$11,340.00 |
| Rate for Payer: Adventist Health Commercial |
$5,166.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,930.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,450.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,399.98
|
| Rate for Payer: Blue Shield of California Commercial |
$9,739.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,350.40
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,080.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,710.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,340.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6,300.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,820.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,820.00
|
| Rate for Payer: Multiplan Commercial |
$9,450.00
|
| Rate for Payer: Networks By Design Commercial |
$6,300.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,040.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,560.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,560.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,710.00
|
| Rate for Payer: Vantage Medical Group Senior |
$10,710.00
|
|
|
HC PARTL HAND EXT POWRD SELF-SUSP
|
Facility
|
IP
|
$12,600.00
|
|
|
Service Code
|
CPT L6025
|
| Hospital Charge Code |
915356025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,520.00 |
| Max. Negotiated Rate |
$11,340.00 |
| Rate for Payer: Adventist Health Commercial |
$2,520.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,739.80
|
| Rate for Payer: Blue Shield of California EPN |
$6,350.40
|
| Rate for Payer: Cash Price |
$6,930.00
|
| Rate for Payer: Central Health Plan Commercial |
$10,080.00
|
| Rate for Payer: Cigna of CA HMO |
$8,820.00
|
| Rate for Payer: Cigna of CA PPO |
$8,820.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,040.00
|
| Rate for Payer: Galaxy Health WC |
$10,710.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,560.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,404.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,800.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,799.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,520.00
|
| Rate for Payer: Multiplan Commercial |
$9,450.00
|
| Rate for Payer: Networks By Design Commercial |
$8,190.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,728.78
|
| Rate for Payer: United Healthcare All Other HMO |
$4,602.78
|
| Rate for Payer: United Healthcare HMO Rider |
$4,503.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,126.50
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
IP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC PASSY MUIR VALVE FOR VENTS
|
Facility
|
OP
|
$288.00
|
|
| Hospital Charge Code |
900800705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.14
|
| Rate for Payer: Blue Shield of California Commercial |
$175.97
|
| Rate for Payer: Blue Shield of California EPN |
$114.91
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: InnovAge PACE Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Riverside University Health System MISP |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.14
|
| Rate for Payer: Blue Shield of California Commercial |
$175.97
|
| Rate for Payer: Blue Shield of California EPN |
$114.91
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: InnovAge PACE Commercial |
$144.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Riverside University Health System MISP |
$115.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.00
|
| Rate for Payer: United Healthcare All Other HMO |
$144.00
|
| Rate for Payer: United Healthcare HMO Rider |
$144.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC PASSY MUIR VALVE SPEAKING
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT L8501
|
| Hospital Charge Code |
900800700
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Central Health Plan Commercial |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$259.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
