|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$16,097.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$9,658.20
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Central Health Plan Commercial |
$12,877.60
|
| Rate for Payer: Cigna of CA PPO |
$11,911.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$13,682.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,658.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,487.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,072.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,736.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,219.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$12,072.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$10,463.05
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$13,682.45
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,658.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,048.50
|
| Rate for Payer: United Healthcare All Other HMO |
$8,048.50
|
| Rate for Payer: United Healthcare HMO Rider |
$8,048.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,048.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$16,097.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,219.40 |
| Max. Negotiated Rate |
$14,487.30 |
| Rate for Payer: Cash Price |
$7,243.65
|
| Rate for Payer: Central Health Plan Commercial |
$12,877.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,438.80
|
| Rate for Payer: Galaxy Health WC |
$13,682.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,658.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,487.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,736.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,132.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,219.40
|
| Rate for Payer: Multiplan Commercial |
$12,072.75
|
| Rate for Payer: Networks By Design Commercial |
$10,463.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,682.45
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| Max. Negotiated Rate |
$3,075.30 |
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,366.80
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,301.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,050.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$784.90
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Cash Price |
$1,537.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,733.60
|
| Rate for Payer: Cigna of CA PPO |
$2,528.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Media |
$784.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.90
|
| Rate for Payer: Galaxy Health WC |
$2,904.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,050.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,075.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,295.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,279.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$683.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.77
|
| Rate for Payer: Multiplan Commercial |
$2,562.75
|
| Rate for Payer: Networks By Design Commercial |
$2,221.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,904.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.99
|
| Rate for Payer: Riverside University Health System MISP |
$863.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,050.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$503.00 |
| Max. Negotiated Rate |
$2,263.50 |
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,012.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.00
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,263.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.00
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$6,248.00 |
| 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 |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,509.00
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,012.00
|
| Rate for Payer: Cigna of CA PPO |
$1,861.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,263.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,886.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,509.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
IP
|
$9,019.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,803.80 |
| Max. Negotiated Rate |
$8,117.10 |
| Rate for Payer: Cash Price |
$4,058.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,215.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,607.60
|
| Rate for Payer: Galaxy Health WC |
$7,666.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,411.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,117.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,015.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,436.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,803.80
|
| Rate for Payer: Multiplan Commercial |
$6,764.25
|
| Rate for Payer: Networks By Design Commercial |
$5,862.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,666.15
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
OP
|
$9,019.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$13,649.79 |
| 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 |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$11,378.77
|
| Rate for Payer: Blue Distinction Transplant |
$5,411.40
|
| Rate for Payer: Caremore Medicare Advantage |
$8,323.04
|
| Rate for Payer: Cash Price |
$4,058.55
|
| Rate for Payer: Cash Price |
$4,058.55
|
| Rate for Payer: Cash Price |
$4,058.55
|
| Rate for Payer: Cash Price |
$4,058.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,215.20
|
| Rate for Payer: Cigna of CA PPO |
$6,674.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$7,666.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,411.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,117.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,764.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,649.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: InnovAge PACE Commercial |
$12,484.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,015.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,803.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,152.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$6,764.25
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: Networks By Design Commercial |
$5,862.35
|
| Rate for Payer: Preferred Health Network WC |
$11,610.99
|
| Rate for Payer: Prime Health Services Commercial |
$7,666.15
|
| Rate for Payer: Prime Health Services Medicare |
$8,822.42
|
| Rate for Payer: Prime Health Services WC |
$11,262.66
|
| Rate for Payer: Riverside University Health System MISP |
$9,155.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,411.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,509.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,509.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,509.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,509.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
OP
|
$6,356.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$8,114.00 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,813.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,084.80
|
| Rate for Payer: Cigna of CA PPO |
$4,703.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,402.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,720.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,767.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$4,767.00
|
| Rate for Payer: Networks By Design Commercial |
$4,131.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,402.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,813.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,178.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,178.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,178.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,178.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
IP
|
$6,356.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,271.20 |
| Max. Negotiated Rate |
$5,720.40 |
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,084.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,542.40
|
| Rate for Payer: Galaxy Health WC |
$5,402.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,720.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,421.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.20
|
| Rate for Payer: Multiplan Commercial |
$4,767.00
|
| Rate for Payer: Networks By Design Commercial |
$4,131.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,402.60
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
OP
|
$9,650.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,685.00 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,790.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,720.00
|
| Rate for Payer: Cigna of CA PPO |
$7,141.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$8,202.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,790.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,685.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,237.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,436.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,930.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$7,237.50
|
| Rate for Payer: Networks By Design Commercial |
$6,272.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,202.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,790.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,825.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,825.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,825.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,825.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
IP
|
$9,650.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,930.00 |
| Max. Negotiated Rate |
$8,685.00 |
| Rate for Payer: Cash Price |
$4,342.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,720.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,860.00
|
| Rate for Payer: Galaxy Health WC |
$8,202.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,790.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,685.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,436.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,676.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,930.00
|
| Rate for Payer: Multiplan Commercial |
$7,237.50
|
| Rate for Payer: Networks By Design Commercial |
$6,272.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,202.50
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
OP
|
$12,697.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$823.38 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,618.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,986.41
|
| Rate for Payer: Blue Shield of California EPN |
$6,208.83
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$5,713.65
|
| Rate for Payer: Cash Price |
$5,713.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,157.60
|
| Rate for Payer: Cigna of CA PPO |
$9,395.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$10,792.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,618.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,427.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,522.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$9,522.75
|
| Rate for Payer: Networks By Design Commercial |
$8,253.05
|
| Rate for Payer: Prime Health Services Commercial |
$10,792.45
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,618.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,618.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
IP
|
$12,697.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,539.40 |
| Max. Negotiated Rate |
$11,427.30 |
| Rate for Payer: Cash Price |
$5,713.65
|
| Rate for Payer: Central Health Plan Commercial |
$10,157.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,078.80
|
| Rate for Payer: Galaxy Health WC |
$10,792.45
|
| Rate for Payer: Global Benefits Group Commercial |
$7,618.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,427.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,468.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,837.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,539.40
|
| Rate for Payer: Multiplan Commercial |
$9,522.75
|
| Rate for Payer: Networks By Design Commercial |
$8,253.05
|
| Rate for Payer: Prime Health Services Commercial |
$10,792.45
|
|
|
HC REPAIR FOOT TENDON
|
Facility
|
IP
|
$8,408.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,681.60 |
| Max. Negotiated Rate |
$7,567.20 |
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,726.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,363.20
|
| Rate for Payer: Galaxy Health WC |
$7,146.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,044.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,567.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,203.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.60
|
| Rate for Payer: Multiplan Commercial |
$6,306.00
|
| Rate for Payer: Networks By Design Commercial |
$5,465.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,146.80
|
|
|
HC REPAIR FOOT TENDON
|
Facility
|
OP
|
$8,408.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,044.80
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Cash Price |
$3,783.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,726.40
|
| Rate for Payer: Cigna of CA PPO |
$6,221.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$7,146.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,044.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,567.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,306.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$6,306.00
|
| Rate for Payer: Networks By Design Commercial |
$5,465.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,146.80
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,044.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
OP
|
$7,945.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,767.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,997.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,885.10
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,356.00
|
| Rate for Payer: Cigna of CA HMO |
$5,084.80
|
| Rate for Payer: Cigna of CA PPO |
$5,879.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,150.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,958.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,672.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$5,958.75
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,767.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,767.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,972.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,972.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
OP
|
$7,945.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,767.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,356.00
|
| Rate for Payer: Cigna of CA PPO |
$5,879.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,150.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,958.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$5,958.75
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,767.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,972.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,972.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,972.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
IP
|
$7,945.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,589.00 |
| Max. Negotiated Rate |
$7,150.50 |
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,356.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,178.00
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,150.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,027.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$5,958.75
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
IP
|
$7,945.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,589.00 |
| Max. Negotiated Rate |
$7,150.50 |
| Rate for Payer: Cash Price |
$3,575.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,356.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,178.00
|
| Rate for Payer: Galaxy Health WC |
$6,753.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,767.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,150.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,299.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,027.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,589.00
|
| Rate for Payer: Multiplan Commercial |
$5,958.75
|
| Rate for Payer: Networks By Design Commercial |
$5,164.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,753.25
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
OP
|
$10,920.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.01 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,552.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,322.62
|
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,736.00
|
| Rate for Payer: Cigna of CA PPO |
$8,080.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Media |
$4,322.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,835.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,322.62
|
| Rate for Payer: Galaxy Health WC |
$9,282.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,552.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,828.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,190.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,089.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: InnovAge PACE Commercial |
$6,483.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,283.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,322.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,184.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,792.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,792.31
|
| Rate for Payer: Multiplan Commercial |
$8,190.00
|
| Rate for Payer: Networks By Design Commercial |
$7,098.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,282.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,581.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,754.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,552.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,460.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,460.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,460.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
IP
|
$10,920.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,184.00 |
| Max. Negotiated Rate |
$9,828.00 |
| Rate for Payer: Cash Price |
$4,914.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,736.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,368.00
|
| Rate for Payer: Galaxy Health WC |
$9,282.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,552.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,828.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,283.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,160.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$8,190.00
|
| Rate for Payer: Networks By Design Commercial |
$7,098.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,282.00
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
IP
|
$13,495.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,699.00 |
| Max. Negotiated Rate |
$12,145.50 |
| Rate for Payer: Cash Price |
$6,072.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,796.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.00
|
| Rate for Payer: Galaxy Health WC |
$11,470.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,097.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,145.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,001.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,141.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,699.00
|
| Rate for Payer: Multiplan Commercial |
$10,121.25
|
| Rate for Payer: Networks By Design Commercial |
$8,771.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,470.75
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
OP
|
$13,495.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$12,145.50 |
| 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 |
$9,795.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,097.00
|
| Rate for Payer: Caremore Medicare Advantage |
$6,530.21
|
| Rate for Payer: Cash Price |
$6,072.75
|
| Rate for Payer: Cash Price |
$6,072.75
|
| Rate for Payer: Cash Price |
$6,072.75
|
| Rate for Payer: Cash Price |
$6,072.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,796.00
|
| Rate for Payer: Cigna of CA PPO |
$9,986.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Media |
$6,530.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,815.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,530.21
|
| Rate for Payer: Galaxy Health WC |
$11,470.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,097.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,145.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,121.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10,709.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,530.21
|
| Rate for Payer: InnovAge PACE Commercial |
$9,795.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,001.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,609.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,530.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,699.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,750.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,750.48
|
| Rate for Payer: Multiplan Commercial |
$10,121.25
|
| Rate for Payer: Networks By Design Commercial |
$8,771.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,470.75
|
| Rate for Payer: Prime Health Services Medicare |
$6,922.02
|
| Rate for Payer: Riverside University Health System MISP |
$7,183.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,097.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,747.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,747.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,747.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,747.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
IP
|
$4,131.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$826.20 |
| Max. Negotiated Rate |
$3,717.90 |
| Rate for Payer: Cash Price |
$1,858.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,304.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,652.40
|
| Rate for Payer: Galaxy Health WC |
$3,511.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,478.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,717.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,755.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,573.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.20
|
| Rate for Payer: Multiplan Commercial |
$3,098.25
|
| Rate for Payer: Networks By Design Commercial |
$2,685.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,511.35
|
|
