|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
915354205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$118.27
|
| Rate for Payer: Blue Shield of California EPN |
$77.11
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$107.10
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$55.89
|
| Rate for Payer: United Healthcare HMO Rider |
$54.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.11
|
|
|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
915354205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$62.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.86
|
| Rate for Payer: Blue Shield of California Commercial |
$118.27
|
| Rate for Payer: Blue Shield of California EPN |
$77.11
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$107.10
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.33
|
| Rate for Payer: InnovAge PACE Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Riverside University Health System MISP |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$55.89
|
| Rate for Payer: United Healthcare HMO Rider |
$54.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.05
|
| Rate for Payer: Vantage Medical Group Senior |
$130.05
|
|
|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
905354205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Blue Shield of California Commercial |
$118.27
|
| Rate for Payer: Blue Shield of California EPN |
$77.11
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$107.10
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$55.89
|
| Rate for Payer: United Healthcare HMO Rider |
$54.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.11
|
|
|
HC REPAIR ORTHOTIC DEVICE 15 MIN
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT L4205
|
| Hospital Charge Code |
905354205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$62.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.86
|
| Rate for Payer: Blue Shield of California Commercial |
$118.27
|
| Rate for Payer: Blue Shield of California EPN |
$77.11
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$107.10
|
| Rate for Payer: Cigna of CA PPO |
$107.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.33
|
| Rate for Payer: InnovAge PACE Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.73
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$76.50
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Riverside University Health System MISP |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.42
|
| Rate for Payer: United Healthcare All Other HMO |
$55.89
|
| Rate for Payer: United Healthcare HMO Rider |
$54.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.05
|
| Rate for Payer: Vantage Medical Group Senior |
$130.05
|
|
|
HC REPAIR ORTHOTIC DEVICE PARTS
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT L4210
|
| Hospital Charge Code |
905354210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.40 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Adventist Health Commercial |
$67.40
|
| Rate for Payer: Blue Shield of California Commercial |
$260.50
|
| Rate for Payer: Blue Shield of California EPN |
$169.85
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Central Health Plan Commercial |
$269.60
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$303.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.40
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: Networks By Design Commercial |
$219.05
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
|
|
HC REPAIR ORTHOTIC DEVICE PARTS
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L4210
|
| Hospital Charge Code |
905354210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.37 |
| Max. Negotiated Rate |
$303.30 |
| Rate for Payer: Adventist Health Commercial |
$138.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.92
|
| Rate for Payer: Blue Shield of California Commercial |
$260.50
|
| Rate for Payer: Blue Shield of California EPN |
$169.85
|
| Rate for Payer: Cash Price |
$185.35
|
| Rate for Payer: Central Health Plan Commercial |
$269.60
|
| Rate for Payer: Cigna of CA HMO |
$235.90
|
| Rate for Payer: Cigna of CA PPO |
$235.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Senior |
$134.80
|
| Rate for Payer: Galaxy Health WC |
$286.45
|
| Rate for Payer: Global Benefits Group Commercial |
$202.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$303.30
|
| Rate for Payer: InnovAge PACE Commercial |
$168.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$208.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.90
|
| Rate for Payer: Multiplan Commercial |
$252.75
|
| Rate for Payer: Networks By Design Commercial |
$168.50
|
| Rate for Payer: Prime Health Services Commercial |
$286.45
|
| Rate for Payer: Riverside University Health System MISP |
$134.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.48
|
| Rate for Payer: United Healthcare All Other HMO |
$123.11
|
| Rate for Payer: United Healthcare HMO Rider |
$120.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$286.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$18,826.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,765.20 |
| Max. Negotiated Rate |
$16,943.40 |
| Rate for Payer: Adventist Health Commercial |
$3,765.20
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Central Health Plan Commercial |
$15,060.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,530.40
|
| Rate for Payer: Galaxy Health WC |
$16,002.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11,295.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,943.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,556.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,172.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,653.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,765.20
|
| Rate for Payer: Multiplan Commercial |
$14,119.50
|
| Rate for Payer: Networks By Design Commercial |
$12,236.90
|
| Rate for Payer: Prime Health Services Commercial |
$16,002.10
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$18,826.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$16,943.40 |
| Rate for Payer: Adventist Health Commercial |
$3,765.20
|
| 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 |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| 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 |
$11,976.10
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Central Health Plan Commercial |
$15,060.80
|
| Rate for Payer: Cigna of CA HMO |
$12,048.64
|
| Rate for Payer: Cigna of CA PPO |
$13,931.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$16,002.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11,295.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,943.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: InnovAge PACE Commercial |
$11,274.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,556.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,765.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,072.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$14,119.50
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$12,236.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Commercial |
$16,002.10
|
| Rate for Payer: Prime Health Services Medicare |
$7,967.43
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,268.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,295.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,413.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9,413.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,413.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,413.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$18,826.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,765.20 |
| Max. Negotiated Rate |
$16,943.40 |
| Rate for Payer: Adventist Health Commercial |
$3,765.20
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Central Health Plan Commercial |
$15,060.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,530.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,530.40
|
| Rate for Payer: Galaxy Health WC |
$16,002.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11,295.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,943.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,556.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,172.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,653.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,765.20
|
| Rate for Payer: Multiplan Commercial |
$14,119.50
|
| Rate for Payer: Networks By Design Commercial |
$12,236.90
|
| Rate for Payer: Prime Health Services Commercial |
$16,002.10
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$18,826.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$16,943.40 |
| Rate for Payer: Adventist Health Commercial |
$7,718.66
|
| 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 |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| 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 |
$11,976.10
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Cash Price |
$10,354.30
|
| Rate for Payer: Central Health Plan Commercial |
$15,060.80
|
| Rate for Payer: Cigna of CA HMO |
$12,048.64
|
| Rate for Payer: Cigna of CA PPO |
$13,931.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$16,002.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11,295.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,943.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: InnovAge PACE Commercial |
$11,274.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,556.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,765.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,072.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$14,119.50
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$12,236.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Preferred Health Network WC |
$12,220.51
|
| Rate for Payer: Prime Health Services Commercial |
$16,002.10
|
| Rate for Payer: Prime Health Services Medicare |
$7,967.43
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Riverside University Health System MISP |
$8,268.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,295.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11,295.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
OP
|
$17,222.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$15,499.80 |
| Rate for Payer: Adventist Health Commercial |
$7,061.02
|
| 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 |
$6,183.90
|
| 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 |
$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 |
$6,568.63
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,777.60
|
| Rate for Payer: Cigna of CA HMO |
$11,022.08
|
| Rate for Payer: Cigna of CA PPO |
$12,744.28
|
| 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 |
$14,638.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,499.80
|
| 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 |
$11,487.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,444.40
|
| 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 |
$12,916.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$11,194.30
|
| 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 |
$14,638.70
|
| 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 |
$10,333.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,333.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| 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 PROFUNDUS TENDON
|
Facility
|
IP
|
$17,222.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,444.40 |
| Max. Negotiated Rate |
$15,499.80 |
| Rate for Payer: Adventist Health Commercial |
$3,444.40
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,777.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,888.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,888.80
|
| Rate for Payer: Galaxy Health WC |
$14,638.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,499.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,487.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,561.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,660.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,444.40
|
| Rate for Payer: Multiplan Commercial |
$12,916.50
|
| Rate for Payer: Networks By Design Commercial |
$11,194.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,638.70
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
OP
|
$17,222.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.20 |
| Max. Negotiated Rate |
$15,499.80 |
| Rate for Payer: Adventist Health Commercial |
$3,444.40
|
| 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 |
$6,183.90
|
| 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 |
$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 |
$6,568.63
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,777.60
|
| Rate for Payer: Cigna of CA HMO |
$11,022.08
|
| Rate for Payer: Cigna of CA PPO |
$12,744.28
|
| 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 |
$14,638.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,499.80
|
| 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 |
$11,487.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,444.40
|
| 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 |
$12,916.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$11,194.30
|
| 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 |
$14,638.70
|
| 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 |
$10,333.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,611.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,611.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,611.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,611.00
|
| 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 PROFUNDUS TENDON
|
Facility
|
IP
|
$17,222.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,444.40 |
| Max. Negotiated Rate |
$15,499.80 |
| Rate for Payer: Adventist Health Commercial |
$3,444.40
|
| Rate for Payer: Cash Price |
$9,472.10
|
| Rate for Payer: Central Health Plan Commercial |
$13,777.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,888.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,888.80
|
| Rate for Payer: Galaxy Health WC |
$14,638.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,499.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,487.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,561.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,660.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,444.40
|
| Rate for Payer: Multiplan Commercial |
$12,916.50
|
| Rate for Payer: Networks By Design Commercial |
$11,194.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,638.70
|
|
|
HC REPAIR PROS DEVICE PER 15MIN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905367520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$31.29 |
| Rate for Payer: Adventist Health Commercial |
$7.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.57
|
| Rate for Payer: Blue Shield of California Commercial |
$13.91
|
| Rate for Payer: Blue Shield of California EPN |
$9.07
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.33
|
| Rate for Payer: InnovAge PACE Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$9.00
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Riverside University Health System MISP |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC REPAIR PROS DEVICE PER 15MIN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905367520
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.91
|
| Rate for Payer: Blue Shield of California EPN |
$9.07
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.76
|
| Rate for Payer: United Healthcare All Other HMO |
$6.58
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$505.53
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$748.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.14
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$319.45
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| 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 |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| 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 |
$319.45
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: Cigna of CA HMO |
$789.12
|
| Rate for Payer: Cigna of CA PPO |
$912.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: InnovAge PACE Commercial |
$300.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$200.49
|
| Rate for Payer: Preferred Health Network WC |
$325.97
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
| Rate for Payer: Prime Health Services Medicare |
$212.52
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Riverside University Health System MISP |
$220.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$739.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.50
|
| Rate for Payer: United Healthcare All Other HMO |
$616.50
|
| Rate for Payer: United Healthcare HMO Rider |
$616.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.60 |
| Max. Negotiated Rate |
$1,109.70 |
| Rate for Payer: Adventist Health Commercial |
$246.60
|
| Rate for Payer: Cash Price |
$678.15
|
| Rate for Payer: Central Health Plan Commercial |
$986.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$493.20
|
| Rate for Payer: Galaxy Health WC |
$1,048.05
|
| Rate for Payer: Global Benefits Group Commercial |
$739.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,109.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.60
|
| Rate for Payer: Multiplan Commercial |
$924.75
|
| Rate for Payer: Networks By Design Commercial |
$801.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.05
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$1,779.00
|
| 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 |
$4,892.25
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: Cigna of CA HMO |
$5,692.80
|
| Rate for Payer: Cigna of CA PPO |
$6,582.30
|
| 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 |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| 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 |
$5,932.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| 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 |
$6,671.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| 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 |
$7,560.75
|
| 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 |
$5,337.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,447.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,447.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,447.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,447.50
|
| 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 TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,779.00 |
| Max. Negotiated Rate |
$8,005.50 |
| Rate for Payer: Adventist Health Commercial |
$1,779.00
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,558.00
|
| Rate for Payer: Galaxy Health WC |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,932.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,388.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,506.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| Rate for Payer: Multiplan Commercial |
$6,671.25
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,560.75
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$348.02 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Commercial |
$3,646.95
|
| 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 |
$4,892.25
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: Cigna of CA HMO |
$5,692.80
|
| Rate for Payer: Cigna of CA PPO |
$6,582.30
|
| 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 |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| 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 |
$5,932.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| 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 |
$6,671.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| 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 |
$7,560.75
|
| 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 |
$5,337.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,337.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$8,895.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,779.00 |
| Max. Negotiated Rate |
$8,005.50 |
| Rate for Payer: Adventist Health Commercial |
$1,779.00
|
| Rate for Payer: Cash Price |
$4,892.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,558.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,558.00
|
| Rate for Payer: Galaxy Health WC |
$7,560.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,337.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,005.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,932.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,388.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,506.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,779.00
|
| Rate for Payer: Multiplan Commercial |
$6,671.25
|
| Rate for Payer: Networks By Design Commercial |
$5,781.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,560.75
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
IP
|
$10,830.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,166.00 |
| Max. Negotiated Rate |
$9,747.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.00
|
| Rate for Payer: Cash Price |
$5,956.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,664.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,332.00
|
| Rate for Payer: Galaxy Health WC |
$9,205.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,223.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,703.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.00
|
| Rate for Payer: Multiplan Commercial |
$8,122.50
|
| Rate for Payer: Networks By Design Commercial |
$7,039.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,205.50
|
|
