|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
OP
|
$41,006.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$36,905.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24,902.94
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19,855.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24,226.34
|
| Rate for Payer: BCBS Transplant Transplant |
$24,603.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Central Health Plan Commercial |
$32,804.80
|
| Rate for Payer: Cigna of CA PPO |
$30,344.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$34,855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$24,603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,905.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$30,754.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: IEHP medi-cal |
$322.03
|
| Rate for Payer: IEHP Medicare Advantage |
$195.17
|
| Rate for Payer: Innovage PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27,351.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,201.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$30,754.50
|
| Rate for Payer: Networks By Design Commercial |
$26,653.90
|
| Rate for Payer: Prime Health Services Commercial |
$34,855.10
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$24,603.60
|
| Rate for Payer: Riverside University Health MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,603.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24,603.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC PARAVALVULAR LEAK TRICUSPID
|
Facility
IP
|
$41,006.00
|
|
|
Service Code
|
CPT 93799
|
| Hospital Charge Code |
906820329
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,201.20 |
| Max. Negotiated Rate |
$36,905.40 |
| Rate for Payer: Cash Price |
$18,452.70
|
| Rate for Payer: Central Health Plan Commercial |
$32,804.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,402.40
|
| Rate for Payer: Galaxy Health WC |
$34,855.10
|
| Rate for Payer: Global Benefits Group Commercial |
$24,603.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,905.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27,351.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,201.20
|
| Rate for Payer: Multiplan Commercial |
$30,754.50
|
| Rate for Payer: Networks By Design Commercial |
$26,653.90
|
| Rate for Payer: Prime Health Services Commercial |
$34,855.10
|
|
|
HC PARENT INFANT GRP OT 60 MIN
|
Facility
IP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC PARENT INFANT GRP OT 60 MIN
|
Facility
OP
|
$585.00
|
|
|
Service Code
|
CPT 97150
|
| Hospital Charge Code |
905104034
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.78 |
| Max. Negotiated Rate |
$526.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$78.78
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$497.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$321.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$321.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$351.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Central Health Plan Commercial |
$468.00
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$526.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$438.75
|
| Rate for Payer: IEHP medi-cal |
$204.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.85
|
| Rate for Payer: Multiplan Commercial |
$438.75
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: Riverside University Health MISP |
$234.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.25
|
| Rate for Payer: Vantage Medical Group Senior |
$497.25
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
OP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
905355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$361.20 |
| Max. Negotiated Rate |
$2,234.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,234.74
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$877.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$567.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$567.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$499.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$609.71
|
| Rate for Payer: BCBS Transplant Transplant |
$619.20
|
| Rate for Payer: Blue Shield of California Commercial |
$774.00
|
| Rate for Payer: Blue Shield of California EPN |
$561.41
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Central Health Plan Commercial |
$825.60
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$877.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$928.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$774.00
|
| Rate for Payer: IEHP medi-cal |
$361.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.12
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$516.00
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: Riverside University Health MISP |
$412.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$516.00
|
| Rate for Payer: United Healthcare All Other HMO |
$516.00
|
| Rate for Payer: United Healthcare HMO Rider |
$516.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$877.20
|
| Rate for Payer: Vantage Medical Group Senior |
$877.20
|
|
|
HC PART FT SHOE INSERT W/TOE FILL
|
Facility
IP
|
$1,032.00
|
|
|
Service Code
|
CPT L5000
|
| Hospital Charge Code |
905355000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$928.80 |
| Rate for Payer: Blue Shield of California EPN |
$551.09
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Central Health Plan Commercial |
$825.60
|
| Rate for Payer: Cigna of CA HMO |
$722.40
|
| Rate for Payer: Cigna of CA PPO |
$722.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$928.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$206.40
|
| Rate for Payer: Multiplan Commercial |
$774.00
|
| Rate for Payer: Networks By Design Commercial |
$516.00
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
|
|
HC PART HAND LITTLE &OR RING FING
|
Facility
IP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
905356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$739.80 |
| Max. Negotiated Rate |
$3,329.10 |
| Rate for Payer: Blue Shield of California EPN |
$1,975.27
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,959.20
|
| Rate for Payer: Cigna of CA HMO |
$2,589.30
|
| Rate for Payer: Cigna of CA PPO |
$2,589.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,479.60
|
| Rate for Payer: Galaxy Health WC |
$3,144.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,219.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,329.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,467.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.80
|
| Rate for Payer: Multiplan Commercial |
$2,774.25
|
| Rate for Payer: Networks By Design Commercial |
$1,849.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,144.15
|
|
|
HC PART HAND LITTLE &OR RING FING
|
Facility
OP
|
$3,699.00
|
|
|
Service Code
|
CPT L6010
|
| Hospital Charge Code |
905356010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,294.65 |
| Max. Negotiated Rate |
$6,539.98 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,539.98
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,144.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,034.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,034.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,791.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,185.37
|
| Rate for Payer: BCBS Transplant Transplant |
$2,219.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,774.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,012.26
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Cash Price |
$1,664.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,959.20
|
| Rate for Payer: Cigna of CA HMO |
$2,589.30
|
| Rate for Payer: Cigna of CA PPO |
$2,589.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,144.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,479.60
|
| Rate for Payer: Galaxy Health WC |
$3,144.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,219.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,329.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,774.25
|
| Rate for Payer: IEHP medi-cal |
$1,294.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,467.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,516.59
|
| Rate for Payer: Multiplan Commercial |
$2,774.25
|
| Rate for Payer: Networks By Design Commercial |
$1,849.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,144.15
|
| Rate for Payer: Riverside University Health MISP |
$1,479.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,219.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,219.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,849.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,849.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,849.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,849.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,144.15
|
| Rate for Payer: Vantage Medical Group Senior |
$3,144.15
|
|
|
HC PART HAND REST MULTIPLE FINGER
|
Facility
IP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
905356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$628.00 |
| Max. Negotiated Rate |
$2,826.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,676.76
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,512.00
|
| Rate for Payer: Cigna of CA HMO |
$2,198.00
|
| Rate for Payer: Cigna of CA PPO |
$2,198.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,256.00
|
| Rate for Payer: Galaxy Health WC |
$2,669.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,884.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,826.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,094.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.00
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| Rate for Payer: Networks By Design Commercial |
$1,570.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
|
|
HC PART HAND REST MULTIPLE FINGER
|
Facility
OP
|
$3,140.00
|
|
|
Service Code
|
CPT L6905
|
| Hospital Charge Code |
905356905
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,099.00 |
| Max. Negotiated Rate |
$6,493.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,493.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,669.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,727.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,727.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,520.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,855.11
|
| Rate for Payer: BCBS Transplant Transplant |
$1,884.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,355.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,708.16
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Cash Price |
$1,413.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,512.00
|
| Rate for Payer: Cigna of CA HMO |
$2,198.00
|
| Rate for Payer: Cigna of CA PPO |
$2,198.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,669.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,256.00
|
| Rate for Payer: Galaxy Health WC |
$2,669.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,884.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,826.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,355.00
|
| Rate for Payer: IEHP medi-cal |
$1,099.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,094.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.40
|
| Rate for Payer: Multiplan Commercial |
$2,355.00
|
| Rate for Payer: Networks By Design Commercial |
$1,570.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,669.00
|
| Rate for Payer: Riverside University Health MISP |
$1,256.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,884.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,669.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,669.00
|
|
|
HC PART HAND REST NO FING REMAIN
|
Facility
IP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
905356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.80 |
| Max. Negotiated Rate |
$2,753.10 |
| Rate for Payer: Blue Shield of California EPN |
$1,633.51
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| Rate for Payer: Cigna of CA HMO |
$2,141.30
|
| Rate for Payer: Cigna of CA PPO |
$2,141.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,223.60
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,753.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: Networks By Design Commercial |
$1,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
|
|
HC PART HAND REST NO FING REMAIN
|
Facility
OP
|
$3,059.00
|
|
|
Service Code
|
CPT L6910
|
| Hospital Charge Code |
905356910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,070.65 |
| Max. Negotiated Rate |
$6,326.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,326.46
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,600.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,682.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,682.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,481.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,807.26
|
| Rate for Payer: BCBS Transplant Transplant |
$1,835.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,294.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,664.10
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Cash Price |
$1,376.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,447.20
|
| Rate for Payer: Cigna of CA HMO |
$2,141.30
|
| Rate for Payer: Cigna of CA PPO |
$2,141.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,600.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,223.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,223.60
|
| Rate for Payer: Galaxy Health WC |
$2,600.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,835.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,753.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,294.25
|
| Rate for Payer: IEHP medi-cal |
$1,070.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,040.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,254.19
|
| Rate for Payer: Multiplan Commercial |
$2,294.25
|
| Rate for Payer: Networks By Design Commercial |
$1,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,600.15
|
| Rate for Payer: Riverside University Health MISP |
$1,223.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,835.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,835.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,529.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,529.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,529.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,529.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,600.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,600.15
|
|
|
HC PART HAND REST REPLACEMT GLOVE
|
Facility
OP
|
$1,549.00
|
|
|
Service Code
|
CPT L6915
|
| Hospital Charge Code |
905356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$542.15 |
| Max. Negotiated Rate |
$2,768.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,768.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,316.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$851.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$851.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$750.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$915.15
|
| Rate for Payer: BCBS Transplant Transplant |
$929.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,161.75
|
| Rate for Payer: Blue Shield of California EPN |
$842.66
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,239.20
|
| Rate for Payer: Cigna of CA HMO |
$1,084.30
|
| Rate for Payer: Cigna of CA PPO |
$1,084.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,316.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$619.60
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,394.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,161.75
|
| Rate for Payer: IEHP medi-cal |
$542.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.09
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| Rate for Payer: Networks By Design Commercial |
$774.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
| Rate for Payer: Riverside University Health MISP |
$619.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$929.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$929.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$774.50
|
| Rate for Payer: United Healthcare All Other HMO |
$774.50
|
| Rate for Payer: United Healthcare HMO Rider |
$774.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$774.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,316.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,316.65
|
|
|
HC PART HAND REST REPLACEMT GLOVE
|
Facility
IP
|
$1,549.00
|
|
|
Service Code
|
CPT L6915
|
| Hospital Charge Code |
905356915
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$309.80 |
| Max. Negotiated Rate |
$1,394.10 |
| Rate for Payer: Blue Shield of California EPN |
$827.17
|
| Rate for Payer: Cash Price |
$697.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,239.20
|
| Rate for Payer: Cigna of CA HMO |
$1,084.30
|
| Rate for Payer: Cigna of CA PPO |
$1,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$619.60
|
| Rate for Payer: Galaxy Health WC |
$1,316.65
|
| Rate for Payer: Global Benefits Group Commercial |
$929.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,394.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.80
|
| Rate for Payer: Multiplan Commercial |
$1,161.75
|
| Rate for Payer: Networks By Design Commercial |
$774.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,316.65
|
|
|
HC PART HAND REST W/GLOVE THMB
|
Facility
OP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
905356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,126.30 |
| Max. Negotiated Rate |
$6,680.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,680.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,735.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,769.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,769.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,558.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,901.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1,930.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,413.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,750.59
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| 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: Dignity Health Commercial/Exchange |
$2,735.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,413.50
|
| Rate for Payer: IEHP medi-cal |
$1,126.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,319.38
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$1,609.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: Riverside University Health MISP |
$1,287.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,609.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,609.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,735.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,735.30
|
|
|
HC PART HAND REST W/GLOVE THMB
|
Facility
IP
|
$3,218.00
|
|
|
Service Code
|
CPT L6900
|
| Hospital Charge Code |
905356900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$643.60 |
| Max. Negotiated Rate |
$2,896.20 |
| Rate for Payer: Blue Shield of California EPN |
$1,718.41
|
| Rate for Payer: Cash Price |
$1,448.10
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$643.60
|
| Rate for Payer: Multiplan Commercial |
$2,413.50
|
| Rate for Payer: Networks By Design Commercial |
$1,609.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
OP
|
$8,006.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,205.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,803.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,404.80
|
| Rate for Payer: Cigna of CA PPO |
$5,924.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,805.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,803.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,205.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,004.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.20
|
| 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 |
$6,004.50
|
| Rate for Payer: Networks By Design Commercial |
$5,203.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,805.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,803.60
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,803.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,003.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,003.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,003.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,003.00
|
| 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 PARTIAL AMPUTATION OF TOE
|
Facility
IP
|
$8,006.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,601.20 |
| Max. Negotiated Rate |
$7,205.40 |
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,202.40
|
| Rate for Payer: Galaxy Health WC |
$6,805.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,803.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,340.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.20
|
| Rate for Payer: Multiplan Commercial |
$6,004.50
|
| Rate for Payer: Networks By Design Commercial |
$5,203.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,805.10
|
|
|
HC PARTIAL AMPUTATION OF TOE
|
Facility
OP
|
$8,006.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,601.20 |
| Max. Negotiated Rate |
$7,205.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,803.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,035.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.93
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,404.80
|
| Rate for Payer: Cigna of CA HMO |
$5,123.84
|
| Rate for Payer: Cigna of CA PPO |
$5,924.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,805.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,803.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,205.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,004.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.20
|
| 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 |
$6,004.50
|
| Rate for Payer: Networks By Design Commercial |
$5,203.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,805.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,803.60
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,803.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,803.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,003.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,003.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,003.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,003.00
|
| 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 PARTIAL AMPUTATION OF TOE
|
Facility
IP
|
$8,006.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
900501505
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,601.20 |
| Max. Negotiated Rate |
$7,205.40 |
| Rate for Payer: Cash Price |
$3,602.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,404.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,202.40
|
| Rate for Payer: Galaxy Health WC |
$6,805.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,803.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,340.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.20
|
| Rate for Payer: Multiplan Commercial |
$6,004.50
|
| Rate for Payer: Networks By Design Commercial |
$5,203.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,805.10
|
|
|
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 |
$1,357.30 |
| Max. Negotiated Rate |
$6,097.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,097.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,296.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,132.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,132.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,877.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,291.12
|
| Rate for Payer: BCBS Transplant Transplant |
$2,326.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,908.50
|
| Rate for Payer: Blue Shield of California EPN |
$2,109.63
|
| Rate for Payer: Cash Price |
$1,745.10
|
| Rate for Payer: Cash Price |
$1,745.10
|
| 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: EPIC Health Plan Commercial |
$1,551.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$2,908.50
|
| Rate for Payer: IEHP medi-cal |
$1,357.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,586.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.98
|
| 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 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 |
$1,939.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,939.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,939.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,939.00
|
| 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 |
905356020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$775.60 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: Blue Shield of California EPN |
$2,070.85
|
| Rate for Payer: Cash Price |
$1,745.10
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$775.60
|
| 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
|
|
|
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 |
$1,414.00 |
| Max. Negotiated Rate |
$5,876.83 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,876.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,434.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,222.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,222.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,956.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,386.83
|
| Rate for Payer: BCBS Transplant Transplant |
$2,424.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,030.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,197.76
|
| Rate for Payer: Cash Price |
$1,818.00
|
| Rate for Payer: Cash Price |
$1,818.00
|
| 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: EPIC Health Plan Commercial |
$1,616.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3,030.00
|
| Rate for Payer: IEHP medi-cal |
$1,414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,694.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,656.40
|
| 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 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 |
$2,020.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,020.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,020.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,020.00
|
| 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
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: Blue Shield of California EPN |
$2,157.36
|
| Rate for Payer: Cash Price |
$1,818.00
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$808.00
|
| 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
|
|
|
HC PARTIAL RMVL DIST PHALANX FNGR
|
Facility
IP
|
$8,089.00
|
|
|
Service Code
|
CPT 26236
|
| Hospital Charge Code |
900501314
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,617.80 |
| Max. Negotiated Rate |
$7,280.10 |
| Rate for Payer: Cash Price |
$3,640.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,471.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,235.60
|
| Rate for Payer: Galaxy Health WC |
$6,875.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,853.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,280.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,395.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,617.80
|
| Rate for Payer: Multiplan Commercial |
$6,066.75
|
| Rate for Payer: Networks By Design Commercial |
$5,257.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,875.65
|
|
