|
HC OFFSET KNEE HEAVY DUTY EA ADDITION LE
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT L2395
|
| Hospital Charge Code |
905352395
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.45 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$158.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.19
|
| Rate for Payer: Blue Distinction Transplant |
$196.20
|
| Rate for Payer: Blue Shield of California Commercial |
$245.25
|
| Rate for Payer: Blue Shield of California EPN |
$177.89
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Central Health Plan Commercial |
$261.60
|
| Rate for Payer: Cigna of CA HMO |
$228.90
|
| Rate for Payer: Cigna of CA PPO |
$228.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Media |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$294.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$245.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$114.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.07
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Networks By Design Commercial |
$163.50
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Riverside University Health System MISP |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.50
|
| Rate for Payer: United Healthcare All Other HMO |
$163.50
|
| Rate for Payer: United Healthcare HMO Rider |
$163.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$163.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.85 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$105.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.84
|
| Rate for Payer: Blue Distinction Transplant |
$114.60
|
| Rate for Payer: Blue Shield of California Commercial |
$143.25
|
| Rate for Payer: Blue Shield of California EPN |
$103.90
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.35
|
| Rate for Payer: Dignity Health Media |
$162.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$162.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$143.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$66.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$117.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.31
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: Riverside University Health System MISP |
$76.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$114.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$114.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.50
|
| Rate for Payer: United Healthcare All Other HMO |
$95.50
|
| Rate for Payer: United Healthcare HMO Rider |
$95.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$162.35
|
| Rate for Payer: Vantage Medical Group Senior |
$162.35
|
|
|
HC OFFSET KNEE JOINT EA ADDITION LE
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT L2390
|
| Hospital Charge Code |
905352390
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Blue Shield of California EPN |
$101.99
|
| Rate for Payer: Cash Price |
$85.95
|
| Rate for Payer: Central Health Plan Commercial |
$152.80
|
| Rate for Payer: Cigna of CA HMO |
$133.70
|
| Rate for Payer: Cigna of CA PPO |
$133.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.40
|
| Rate for Payer: Galaxy Health WC |
$162.35
|
| Rate for Payer: Global Benefits Group Commercial |
$114.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$171.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.20
|
| Rate for Payer: Multiplan Commercial |
$143.25
|
| Rate for Payer: Networks By Design Commercial |
$95.50
|
| Rate for Payer: Prime Health Services Commercial |
$162.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$72.12
|
| Rate for Payer: United Healthcare All Other HMO |
$70.44
|
| Rate for Payer: United Healthcare HMO Rider |
$68.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.03
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
IP
|
$36.98
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
|
|
HC OINTMENT SKIN PROTECTANT 2.5OZ
|
Facility
|
OP
|
$36.98
|
|
| Hospital Charge Code |
901698669
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.85
|
| Rate for Payer: Blue Distinction Transplant |
$22.19
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.08
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$29.58
|
| Rate for Payer: Cigna of CA HMO |
$23.67
|
| Rate for Payer: Cigna of CA PPO |
$27.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.43
|
| Rate for Payer: Dignity Health Media |
$31.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
| Rate for Payer: Riverside University Health System MISP |
$14.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Other HMO |
$18.49
|
| Rate for Payer: United Healthcare HMO Rider |
$18.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Vantage Medical Group Senior |
$31.43
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
OP
|
$12,751.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$14,659.19 |
| 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 |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$7,650.60
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$5,737.95
|
| Rate for Payer: Cash Price |
$5,737.95
|
| Rate for Payer: Cash Price |
$5,737.95
|
| Rate for Payer: Cash Price |
$5,737.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,200.80
|
| Rate for Payer: Cigna of CA PPO |
$9,435.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$10,838.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,650.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,475.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,563.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,550.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$9,563.25
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$8,288.15
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$10,838.35
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,650.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,375.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,375.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,375.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,375.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPEN FX DISTAL TIBIA/FIBULA
|
Facility
|
IP
|
$12,751.00
|
|
|
Service Code
|
CPT 27814
|
| Hospital Charge Code |
900501606
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,550.20 |
| Max. Negotiated Rate |
$11,475.90 |
| Rate for Payer: Cash Price |
$5,737.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,200.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,100.40
|
| Rate for Payer: Galaxy Health WC |
$10,838.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,650.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,475.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,858.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,550.20
|
| Rate for Payer: Multiplan Commercial |
$9,563.25
|
| Rate for Payer: Networks By Design Commercial |
$8,288.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,838.35
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
IP
|
$26,062.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5,212.40 |
| Max. Negotiated Rate |
$23,455.80 |
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Central Health Plan Commercial |
$20,849.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,424.80
|
| Rate for Payer: Galaxy Health WC |
$22,152.70
|
| Rate for Payer: Global Benefits Group Commercial |
$15,637.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,455.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,383.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,929.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,212.40
|
| Rate for Payer: Multiplan Commercial |
$19,546.50
|
| Rate for Payer: Networks By Design Commercial |
$16,940.30
|
| Rate for Payer: Prime Health Services Commercial |
$22,152.70
|
|
|
HC OPEN TREAT ELBOW DISLOCATION
|
Facility
|
OP
|
$26,062.00
|
|
|
Service Code
|
CPT 24615
|
| Hospital Charge Code |
900524615
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$23,455.80 |
| 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 |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$15,637.20
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Cash Price |
$11,727.90
|
| Rate for Payer: Central Health Plan Commercial |
$20,849.60
|
| Rate for Payer: Cigna of CA PPO |
$19,285.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$22,152.70
|
| Rate for Payer: Global Benefits Group Commercial |
$15,637.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,455.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19,546.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,383.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,212.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$19,546.50
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$16,940.30
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$22,152.70
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,637.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,031.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,031.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,031.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,031.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
IP
|
$17,489.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,497.80 |
| Max. Negotiated Rate |
$15,740.10 |
| Rate for Payer: Cash Price |
$7,870.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,991.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,995.60
|
| Rate for Payer: Galaxy Health WC |
$14,865.65
|
| Rate for Payer: Global Benefits Group Commercial |
$10,493.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,740.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,665.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,663.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,497.80
|
| Rate for Payer: Multiplan Commercial |
$13,116.75
|
| Rate for Payer: Networks By Design Commercial |
$11,367.85
|
| Rate for Payer: Prime Health Services Commercial |
$14,865.65
|
|
|
HC OPEN TREAT FINGER FX, EA
|
Facility
|
OP
|
$17,489.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
900501422
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,740.10 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,493.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$7,870.05
|
| Rate for Payer: Cash Price |
$7,870.05
|
| Rate for Payer: Cash Price |
$7,870.05
|
| Rate for Payer: Cash Price |
$7,870.05
|
| Rate for Payer: Central Health Plan Commercial |
$13,991.20
|
| Rate for Payer: Cigna of CA PPO |
$12,941.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$14,865.65
|
| Rate for Payer: Global Benefits Group Commercial |
$10,493.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,740.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,116.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,665.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,497.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$13,116.75
|
| Rate for Payer: Networks By Design Commercial |
$11,367.85
|
| Rate for Payer: Prime Health Services Commercial |
$14,865.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,493.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,744.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,744.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,744.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,744.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$13,974.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,794.80 |
| Max. Negotiated Rate |
$12,576.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,384.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,789.65
|
| Rate for Payer: Blue Shield of California EPN |
$6,833.29
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Central Health Plan Commercial |
$11,179.20
|
| Rate for Payer: Cigna of CA HMO |
$8,943.36
|
| Rate for Payer: Cigna of CA PPO |
$10,340.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$11,877.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,384.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,576.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,480.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,320.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,794.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,480.50
|
| Rate for Payer: Networks By Design Commercial |
$9,083.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,877.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,384.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,384.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,987.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,987.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,987.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$13,974.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,794.80 |
| Max. Negotiated Rate |
$12,576.60 |
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Central Health Plan Commercial |
$11,179.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,589.60
|
| Rate for Payer: Galaxy Health WC |
$11,877.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,384.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,576.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,320.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,324.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,794.80
|
| Rate for Payer: Multiplan Commercial |
$10,480.50
|
| Rate for Payer: Networks By Design Commercial |
$9,083.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,877.90
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
IP
|
$13,974.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,794.80 |
| Max. Negotiated Rate |
$12,576.60 |
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Central Health Plan Commercial |
$11,179.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,589.60
|
| Rate for Payer: Galaxy Health WC |
$11,877.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,384.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,576.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,320.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,324.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,794.80
|
| Rate for Payer: Multiplan Commercial |
$10,480.50
|
| Rate for Payer: Networks By Design Commercial |
$9,083.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,877.90
|
|
|
HC OPEN TREAT FINGER/THUMB FX EA
|
Facility
|
OP
|
$13,974.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
900501389
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$12,576.60 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,384.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Cash Price |
$6,288.30
|
| Rate for Payer: Central Health Plan Commercial |
$11,179.20
|
| Rate for Payer: Cigna of CA PPO |
$10,340.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$11,877.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,384.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,576.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,480.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,320.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,794.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,480.50
|
| Rate for Payer: Networks By Design Commercial |
$9,083.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,877.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,384.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,987.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,987.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,987.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,987.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
IP
|
$14,727.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,945.40 |
| Max. Negotiated Rate |
$13,254.30 |
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Central Health Plan Commercial |
$11,781.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.80
|
| Rate for Payer: Galaxy Health WC |
$12,517.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,836.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,254.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,822.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,610.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,945.40
|
| Rate for Payer: Multiplan Commercial |
$11,045.25
|
| Rate for Payer: Networks By Design Commercial |
$9,572.55
|
| Rate for Payer: Prime Health Services Commercial |
$12,517.95
|
|
|
HC OPEN TREAT/FINGER/TOE FRACTURE
|
Facility
|
OP
|
$14,727.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
900501351
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,254.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,836.20
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Cash Price |
$6,627.15
|
| Rate for Payer: Central Health Plan Commercial |
$11,781.60
|
| Rate for Payer: Cigna of CA PPO |
$10,897.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$12,517.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,836.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,254.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,045.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,822.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$428.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,945.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$11,045.25
|
| Rate for Payer: Networks By Design Commercial |
$9,572.55
|
| Rate for Payer: Prime Health Services Commercial |
$12,517.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,836.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,363.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,363.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,363.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,363.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$13,654.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$12,288.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,192.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,588.37
|
| Rate for Payer: Blue Shield of California EPN |
$6,676.81
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,923.20
|
| Rate for Payer: Cigna of CA HMO |
$8,738.56
|
| Rate for Payer: Cigna of CA PPO |
$10,103.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$11,605.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,192.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,288.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,240.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,730.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,240.50
|
| Rate for Payer: Networks By Design Commercial |
$8,875.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,605.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,192.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,192.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,827.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,827.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,827.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$13,654.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.19 |
| Max. Negotiated Rate |
$12,288.60 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,192.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,923.20
|
| Rate for Payer: Cigna of CA PPO |
$10,103.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$11,605.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,192.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,288.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,240.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,730.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$10,240.50
|
| Rate for Payer: Networks By Design Commercial |
$8,875.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,605.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,192.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,827.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,827.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,827.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$13,654.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,730.80 |
| Max. Negotiated Rate |
$12,288.60 |
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,461.60
|
| Rate for Payer: Galaxy Health WC |
$11,605.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,192.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,288.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,202.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,730.80
|
| Rate for Payer: Multiplan Commercial |
$10,240.50
|
| Rate for Payer: Networks By Design Commercial |
$8,875.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,605.90
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$13,654.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,730.80 |
| Max. Negotiated Rate |
$12,288.60 |
| Rate for Payer: Cash Price |
$6,144.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,461.60
|
| Rate for Payer: Galaxy Health WC |
$11,605.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8,192.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,288.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,202.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,730.80
|
| Rate for Payer: Multiplan Commercial |
$10,240.50
|
| Rate for Payer: Networks By Design Commercial |
$8,875.10
|
| Rate for Payer: Prime Health Services Commercial |
$11,605.90
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
IP
|
$11,230.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,246.00 |
| Max. Negotiated Rate |
$10,107.00 |
| Rate for Payer: Cash Price |
$5,053.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,984.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,492.00
|
| Rate for Payer: Galaxy Health WC |
$9,545.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,738.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,107.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,490.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,278.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,246.00
|
| Rate for Payer: Multiplan Commercial |
$8,422.50
|
| Rate for Payer: Networks By Design Commercial |
$7,299.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,545.50
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
OP
|
$11,230.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$11,999.72 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,003.24
|
| Rate for Payer: Blue Distinction Transplant |
$6,738.00
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Cash Price |
$5,053.50
|
| Rate for Payer: Cash Price |
$5,053.50
|
| Rate for Payer: Cash Price |
$5,053.50
|
| Rate for Payer: Cash Price |
$5,053.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,984.00
|
| Rate for Payer: Cigna of CA PPO |
$8,310.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Galaxy Health WC |
$9,545.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,738.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,107.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,422.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: InnovAge PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,490.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,246.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan Commercial |
$8,422.50
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Networks By Design Commercial |
$7,299.50
|
| Rate for Payer: Preferred Health Network WC |
$10,207.39
|
| Rate for Payer: Prime Health Services Commercial |
$9,545.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Riverside University Health System MISP |
$8,048.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,738.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,615.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,615.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,615.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
IP
|
$12,115.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,423.00 |
| Max. Negotiated Rate |
$10,903.50 |
| Rate for Payer: Cash Price |
$5,451.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,692.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,846.00
|
| Rate for Payer: Galaxy Health WC |
$10,297.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,903.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,080.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,615.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,423.00
|
| Rate for Payer: Multiplan Commercial |
$9,086.25
|
| Rate for Payer: Networks By Design Commercial |
$7,874.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,297.75
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
OP
|
$12,115.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,269.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,620.34
|
| Rate for Payer: Blue Shield of California EPN |
$5,924.24
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$5,451.75
|
| Rate for Payer: Cash Price |
$5,451.75
|
| Rate for Payer: Central Health Plan Commercial |
$9,692.00
|
| Rate for Payer: Cigna of CA PPO |
$8,965.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$10,297.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,269.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,903.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,086.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,080.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,423.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$9,086.25
|
| Rate for Payer: Networks By Design Commercial |
$7,874.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,297.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,269.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,269.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
