|
HC REPAIR HAND JOINT
|
Facility
|
IP
|
$10,508.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,101.60 |
| Max. Negotiated Rate |
$9,457.20 |
| Rate for Payer: Adventist Health Commercial |
$2,101.60
|
| Rate for Payer: Cash Price |
$5,779.40
|
| Rate for Payer: Central Health Plan Commercial |
$8,406.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,203.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,203.20
|
| Rate for Payer: Galaxy Health WC |
$8,931.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,304.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,457.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,008.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,003.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,504.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,101.60
|
| Rate for Payer: Multiplan Commercial |
$7,881.00
|
| Rate for Payer: Networks By Design Commercial |
$6,830.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,931.80
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
IP
|
$14,442.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,888.40 |
| Max. Negotiated Rate |
$12,997.80 |
| Rate for Payer: Adventist Health Commercial |
$2,888.40
|
| Rate for Payer: Cash Price |
$7,943.10
|
| Rate for Payer: Central Health Plan Commercial |
$11,553.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,776.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,776.80
|
| Rate for Payer: Galaxy Health WC |
$12,275.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,665.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,997.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,632.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,502.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,939.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,888.40
|
| Rate for Payer: Multiplan Commercial |
$10,831.50
|
| Rate for Payer: Networks By Design Commercial |
$9,387.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,275.70
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
OP
|
$14,442.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.01 |
| Max. Negotiated Rate |
$15,320.00 |
| Rate for Payer: Adventist Health Commercial |
$2,888.40
|
| 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 |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Cash Price |
$7,943.10
|
| Rate for Payer: Cash Price |
$7,943.10
|
| Rate for Payer: Cash Price |
$7,943.10
|
| Rate for Payer: Cash Price |
$7,943.10
|
| Rate for Payer: Central Health Plan Commercial |
$11,553.60
|
| Rate for Payer: Cigna of CA HMO |
$9,242.88
|
| Rate for Payer: Cigna of CA PPO |
$10,687.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$12,275.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,665.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,997.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: InnovAge PACE Commercial |
$6,726.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,632.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,888.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,008.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$10,831.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$9,387.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,275.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,753.06
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$4,932.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,665.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,221.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,221.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
IP
|
$16,707.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,341.40 |
| Max. Negotiated Rate |
$15,036.30 |
| Rate for Payer: Adventist Health Commercial |
$3,341.40
|
| Rate for Payer: Cash Price |
$9,188.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,365.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,682.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,682.80
|
| Rate for Payer: Galaxy Health WC |
$14,200.95
|
| Rate for Payer: Global Benefits Group Commercial |
$10,024.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,036.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,143.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,365.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,341.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,341.40
|
| Rate for Payer: Multiplan Commercial |
$12,530.25
|
| Rate for Payer: Networks By Design Commercial |
$10,859.55
|
| Rate for Payer: Prime Health Services Commercial |
$14,200.95
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
OP
|
$16,707.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,036.30 |
| Rate for Payer: Adventist Health Commercial |
$3,341.40
|
| 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 |
$9,833.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,211.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,555.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,445.70
|
| Rate for Payer: Cash Price |
$9,188.85
|
| Rate for Payer: Cash Price |
$9,188.85
|
| Rate for Payer: Cash Price |
$9,188.85
|
| Rate for Payer: Cash Price |
$9,188.85
|
| Rate for Payer: Central Health Plan Commercial |
$13,365.60
|
| Rate for Payer: Cigna of CA HMO |
$10,692.48
|
| Rate for Payer: Cigna of CA PPO |
$12,363.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,833.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,211.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,555.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,850.51
|
| Rate for Payer: EPIC Health Plan Senior |
$6,555.93
|
| Rate for Payer: Galaxy Health WC |
$14,200.95
|
| Rate for Payer: Global Benefits Group Commercial |
$10,024.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,036.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,751.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,555.93
|
| Rate for Payer: InnovAge PACE Commercial |
$9,833.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,143.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,609.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,555.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,341.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,784.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,784.95
|
| Rate for Payer: Multiplan Commercial |
$12,530.25
|
| Rate for Payer: Multiplan WC |
$10,445.70
|
| Rate for Payer: Networks By Design Commercial |
$10,859.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,555.93
|
| Rate for Payer: Preferred Health Network WC |
$10,658.88
|
| Rate for Payer: Prime Health Services Commercial |
$14,200.95
|
| Rate for Payer: Prime Health Services Medicare |
$6,949.29
|
| Rate for Payer: Prime Health Services WC |
$10,339.11
|
| Rate for Payer: Riverside University Health System MISP |
$7,211.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,024.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,353.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,353.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,353.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,353.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,555.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,833.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,211.52
|
| Rate for Payer: Vantage Medical Group Senior |
$6,555.93
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
IP
|
$4,513.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$902.60 |
| Max. Negotiated Rate |
$4,061.70 |
| Rate for Payer: Adventist Health Commercial |
$902.60
|
| Rate for Payer: Cash Price |
$2,482.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,610.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,805.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,805.20
|
| Rate for Payer: Galaxy Health WC |
$3,836.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,061.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,010.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,719.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,793.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.60
|
| Rate for Payer: Multiplan Commercial |
$3,384.75
|
| Rate for Payer: Networks By Design Commercial |
$2,933.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,836.05
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
OP
|
$4,513.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$902.60
|
| 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 |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$2,482.15
|
| Rate for Payer: Cash Price |
$2,482.15
|
| Rate for Payer: Cash Price |
$2,482.15
|
| Rate for Payer: Cash Price |
$2,482.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,610.40
|
| Rate for Payer: Cigna of CA HMO |
$2,888.32
|
| Rate for Payer: Cigna of CA PPO |
$3,339.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$3,836.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,707.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,061.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,010.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$902.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$3,384.75
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$2,933.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$3,836.05
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,707.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,256.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,256.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,256.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,256.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
OP
|
$6,611.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: Cigna of CA HMO |
$4,231.04
|
| Rate for Payer: Cigna of CA PPO |
$4,892.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,966.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,305.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,305.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,305.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
IP
|
$6,611.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,322.20 |
| Max. Negotiated Rate |
$5,949.90 |
| Rate for Payer: Adventist Health Commercial |
$1,322.20
|
| Rate for Payer: Cash Price |
$3,636.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,288.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,644.40
|
| Rate for Payer: Galaxy Health WC |
$5,619.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,949.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,409.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,518.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,092.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,322.20
|
| Rate for Payer: Multiplan Commercial |
$4,958.25
|
| Rate for Payer: Networks By Design Commercial |
$4,297.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,619.35
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.15 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$556.05
|
| Rate for Payer: Cash Price |
$556.05
|
| Rate for Payer: Cash Price |
$556.05
|
| Rate for Payer: Cash Price |
$556.05
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.50
|
| Rate for Payer: United Healthcare All Other HMO |
$505.50
|
| Rate for Payer: United Healthcare HMO Rider |
$505.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Cash Price |
$556.05
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,786.40 |
| Max. Negotiated Rate |
$8,038.80 |
| Rate for Payer: Adventist Health Commercial |
$1,786.40
|
| Rate for Payer: Cash Price |
$4,912.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,145.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,572.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,572.80
|
| Rate for Payer: Galaxy Health WC |
$7,592.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,359.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,038.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,957.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,403.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,528.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,786.40
|
| Rate for Payer: Multiplan Commercial |
$6,699.00
|
| Rate for Payer: Networks By Design Commercial |
$5,805.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,592.20
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$1,786.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$4,912.60
|
| Rate for Payer: Cash Price |
$4,912.60
|
| Rate for Payer: Cash Price |
$4,912.60
|
| Rate for Payer: Cash Price |
$4,912.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,145.60
|
| Rate for Payer: Cigna of CA HMO |
$5,716.48
|
| Rate for Payer: Cigna of CA PPO |
$6,609.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,592.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,359.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,038.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,957.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,786.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,699.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,805.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$7,592.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,359.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,466.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
IP
|
$8,798.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,759.60 |
| Max. Negotiated Rate |
$7,918.20 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| Rate for Payer: Cash Price |
$4,838.90
|
| Rate for Payer: Central Health Plan Commercial |
$7,038.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,519.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,519.20
|
| Rate for Payer: Galaxy Health WC |
$7,478.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,278.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,918.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,868.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,352.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,445.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.60
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: Networks By Design Commercial |
$5,718.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,478.30
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
OP
|
$8,798.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.50 |
| Max. Negotiated Rate |
$10,751.73 |
| Rate for Payer: Adventist Health Commercial |
$1,759.60
|
| 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 |
$9,833.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,211.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,555.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,445.70
|
| Rate for Payer: Cash Price |
$4,838.90
|
| Rate for Payer: Cash Price |
$4,838.90
|
| Rate for Payer: Cash Price |
$4,838.90
|
| Rate for Payer: Cash Price |
$4,838.90
|
| Rate for Payer: Central Health Plan Commercial |
$7,038.40
|
| Rate for Payer: Cigna of CA HMO |
$5,630.72
|
| Rate for Payer: Cigna of CA PPO |
$6,510.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,833.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,211.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,555.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,850.51
|
| Rate for Payer: EPIC Health Plan Senior |
$6,555.93
|
| Rate for Payer: Galaxy Health WC |
$7,478.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,278.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,918.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,751.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,555.93
|
| Rate for Payer: InnovAge PACE Commercial |
$9,833.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,868.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,555.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,759.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,784.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,784.95
|
| Rate for Payer: Multiplan Commercial |
$6,598.50
|
| Rate for Payer: Multiplan WC |
$10,445.70
|
| Rate for Payer: Networks By Design Commercial |
$5,718.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,555.93
|
| Rate for Payer: Preferred Health Network WC |
$10,658.88
|
| Rate for Payer: Prime Health Services Commercial |
$7,478.30
|
| Rate for Payer: Prime Health Services Medicare |
$6,949.29
|
| Rate for Payer: Prime Health Services WC |
$10,339.11
|
| Rate for Payer: Riverside University Health System MISP |
$7,211.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,278.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,399.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,399.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,399.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,555.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,833.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,211.52
|
| Rate for Payer: Vantage Medical Group Senior |
$6,555.93
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$8,009.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,208.10 |
| Rate for Payer: Adventist Health Commercial |
$1,601.80
|
| 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 |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,407.20
|
| Rate for Payer: Cigna of CA HMO |
$5,125.76
|
| Rate for Payer: Cigna of CA PPO |
$5,926.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$6,807.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,208.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4,446.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,972.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$6,006.75
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$5,205.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,807.65
|
| Rate for Payer: Prime Health Services Medicare |
$3,142.12
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,805.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,004.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$8,009.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,208.10 |
| Rate for Payer: Adventist Health Commercial |
$3,283.69
|
| 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 |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,407.20
|
| Rate for Payer: Cigna of CA HMO |
$5,125.76
|
| Rate for Payer: Cigna of CA PPO |
$5,926.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$6,807.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,208.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4,446.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,972.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$6,006.75
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$5,205.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,807.65
|
| Rate for Payer: Prime Health Services Medicare |
$3,142.12
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,805.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,805.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$8,009.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,601.80 |
| Max. Negotiated Rate |
$7,208.10 |
| Rate for Payer: Adventist Health Commercial |
$1,601.80
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,203.60
|
| Rate for Payer: Galaxy Health WC |
$6,807.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,208.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,051.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,957.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.80
|
| Rate for Payer: Multiplan Commercial |
$6,006.75
|
| Rate for Payer: Networks By Design Commercial |
$5,205.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,807.65
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$8,009.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,601.80 |
| Max. Negotiated Rate |
$7,208.10 |
| Rate for Payer: Adventist Health Commercial |
$1,601.80
|
| Rate for Payer: Cash Price |
$4,404.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,407.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,203.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,203.60
|
| Rate for Payer: Galaxy Health WC |
$6,807.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,805.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,208.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,051.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,957.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.80
|
| Rate for Payer: Multiplan Commercial |
$6,006.75
|
| Rate for Payer: Networks By Design Commercial |
$5,205.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,807.65
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
IP
|
$2,701.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$540.20 |
| Max. Negotiated Rate |
$2,430.90 |
| Rate for Payer: Adventist Health Commercial |
$540.20
|
| Rate for Payer: Cash Price |
$1,485.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,080.40
|
| Rate for Payer: Galaxy Health WC |
$2,295.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,801.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,029.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.20
|
| Rate for Payer: Multiplan Commercial |
$2,025.75
|
| Rate for Payer: Networks By Design Commercial |
$1,755.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.85
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
OP
|
$2,701.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$348.35 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$540.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,485.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,485.55
|
| Rate for Payer: Cash Price |
$1,485.55
|
| Rate for Payer: Cash Price |
$1,485.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.80
|
| Rate for Payer: Cigna of CA HMO |
$1,728.64
|
| Rate for Payer: Cigna of CA PPO |
$1,998.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,295.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,295.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,080.40
|
| Rate for Payer: Galaxy Health WC |
$2,295.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$348.35
|
| Rate for Payer: InnovAge PACE Commercial |
$1,350.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,801.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,671.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,890.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,890.70
|
| Rate for Payer: Multiplan Commercial |
$2,025.75
|
| Rate for Payer: Networks By Design Commercial |
$1,755.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,080.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,620.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,295.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,295.85
|
|
|
HC REPAIR OF PROSTH HOURLY
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L7500
|
| Hospital Charge Code |
905357500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
|
|
HC REPAIR OF PROSTH HOURLY
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L7500
|
| Hospital Charge Code |
905357500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Adventist Health Commercial |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.78
|
| Rate for Payer: Blue Shield of California Commercial |
$37.88
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: InnovAge PACE Commercial |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Riverside University Health System MISP |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.39
|
| Rate for Payer: United Healthcare All Other HMO |
$17.90
|
| Rate for Payer: United Healthcare HMO Rider |
$17.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$11,962.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,392.40 |
| Max. Negotiated Rate |
$10,765.80 |
| Rate for Payer: Adventist Health Commercial |
$2,392.40
|
| Rate for Payer: Cash Price |
$6,579.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,569.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,784.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,784.80
|
| Rate for Payer: Galaxy Health WC |
$10,167.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,177.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,765.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,978.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,557.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,404.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.40
|
| Rate for Payer: Multiplan Commercial |
$8,971.50
|
| Rate for Payer: Networks By Design Commercial |
$7,775.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,167.70
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$11,962.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$2,392.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$6,579.10
|
| Rate for Payer: Cash Price |
$6,579.10
|
| Rate for Payer: Cash Price |
$6,579.10
|
| Rate for Payer: Cash Price |
$6,579.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,569.60
|
| Rate for Payer: Cigna of CA HMO |
$7,655.68
|
| Rate for Payer: Cigna of CA PPO |
$8,851.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$10,167.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,177.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,765.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,978.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$8,971.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$7,775.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,167.70
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,177.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,981.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,981.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,981.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,981.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
