|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
OP
|
$4,131.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| 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 |
$2,478.60
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$1,858.95
|
| Rate for Payer: Cash Price |
$1,858.95
|
| Rate for Payer: Cash Price |
$1,858.95
|
| Rate for Payer: Cash Price |
$1,858.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,304.80
|
| Rate for Payer: Cigna of CA PPO |
$3,056.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| 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: Health Plan of Nevada (Sierra) Other |
$3,098.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,755.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health System MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,478.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,065.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,065.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,065.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,065.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
OP
|
$4,999.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$4,499.10 |
| 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 |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,999.40
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,999.20
|
| Rate for Payer: Cigna of CA PPO |
$3,699.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,499.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,749.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$999.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$3,749.25
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health System MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,999.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,499.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,499.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,499.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,499.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
IP
|
$4,999.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$999.80 |
| Max. Negotiated Rate |
$4,499.10 |
| Rate for Payer: Cash Price |
$2,249.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,999.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,999.60
|
| Rate for Payer: Galaxy Health WC |
$4,249.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,999.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,499.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,334.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,904.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$999.80
|
| Rate for Payer: Multiplan Commercial |
$3,749.25
|
| Rate for Payer: Networks By Design Commercial |
$3,249.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,249.15
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
OP
|
$764.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$130.15 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$458.40
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: Cigna of CA PPO |
$565.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$573.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$458.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.00
|
| Rate for Payer: United Healthcare All Other HMO |
$382.00
|
| Rate for Payer: United Healthcare HMO Rider |
$382.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$382.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC REPAIR MOUTH LACERATION LT 2.5CM
|
Facility
|
IP
|
$764.00
|
|
|
Service Code
|
CPT 40830
|
| Hospital Charge Code |
900540830
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$152.80 |
| Max. Negotiated Rate |
$687.60 |
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Central Health Plan Commercial |
$611.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.60
|
| Rate for Payer: Galaxy Health WC |
$649.40
|
| Rate for Payer: Global Benefits Group Commercial |
$458.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$687.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$509.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.80
|
| Rate for Payer: Multiplan Commercial |
$573.00
|
| Rate for Payer: Networks By Design Commercial |
$496.60
|
| Rate for Payer: Prime Health Services Commercial |
$649.40
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
OP
|
$6,754.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health 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 |
$4,052.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,039.30
|
| Rate for Payer: Cash Price |
$3,039.30
|
| Rate for Payer: Cash Price |
$3,039.30
|
| Rate for Payer: Cash Price |
$3,039.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,403.20
|
| Rate for Payer: Cigna of CA PPO |
$4,997.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,740.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,052.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,078.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,065.50
|
| 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 |
$4,504.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$5,065.50
|
| Rate for Payer: Networks By Design Commercial |
$4,390.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,052.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,377.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,377.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,377.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,377.00
|
| 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 MUSCLES OF HAND, EA
|
Facility
|
IP
|
$6,754.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,350.80 |
| Max. Negotiated Rate |
$6,078.60 |
| Rate for Payer: Cash Price |
$3,039.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,403.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.60
|
| Rate for Payer: Galaxy Health WC |
$5,740.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,052.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,078.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,573.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,350.80
|
| Rate for Payer: Multiplan Commercial |
$5,065.50
|
| Rate for Payer: Networks By Design Commercial |
$4,390.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,740.90
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
IP
|
$7,107.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,421.40 |
| Max. Negotiated Rate |
$6,396.30 |
| Rate for Payer: Cash Price |
$3,198.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,842.80
|
| Rate for Payer: Galaxy Health WC |
$6,040.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,264.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,396.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,740.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,707.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,421.40
|
| Rate for Payer: Multiplan Commercial |
$5,330.25
|
| Rate for Payer: Networks By Design Commercial |
$4,619.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,040.95
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
OP
|
$7,107.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.50 |
| Max. Negotiated Rate |
$10,709.54 |
| 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 |
$4,264.20
|
| Rate for Payer: Caremore Medicare Advantage |
$6,530.21
|
| Rate for Payer: Cash Price |
$3,198.15
|
| Rate for Payer: Cash Price |
$3,198.15
|
| Rate for Payer: Cash Price |
$3,198.15
|
| Rate for Payer: Cash Price |
$3,198.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,685.60
|
| Rate for Payer: Cigna of CA PPO |
$5,259.18
|
| 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 |
$6,040.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,264.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,396.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,330.25
|
| 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 |
$4,740.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,530.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,421.40
|
| 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 |
$5,330.25
|
| Rate for Payer: Networks By Design Commercial |
$4,619.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,040.95
|
| 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 |
$4,264.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,553.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,553.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,553.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,553.50
|
| 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 OF EYE/LID WOUND
|
Facility
|
IP
|
$6,470.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,294.00 |
| Max. Negotiated Rate |
$5,823.00 |
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,588.00
|
| Rate for Payer: Galaxy Health WC |
$5,499.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,882.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,823.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,465.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,294.00
|
| Rate for Payer: Multiplan Commercial |
$4,852.50
|
| Rate for Payer: Networks By Design Commercial |
$4,205.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,499.50
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$6,470.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| 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 |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| 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 |
$3,882.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,176.00
|
| Rate for Payer: Cigna of CA PPO |
$4,787.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$5,499.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,882.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,823.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,852.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,315.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,294.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$4,852.50
|
| Rate for Payer: Networks By Design Commercial |
$4,205.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,499.50
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,882.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,235.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$6,470.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,294.00 |
| Max. Negotiated Rate |
$5,823.00 |
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,588.00
|
| Rate for Payer: Galaxy Health WC |
$5,499.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,882.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,823.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,315.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,465.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,294.00
|
| Rate for Payer: Multiplan Commercial |
$4,852.50
|
| Rate for Payer: Networks By Design Commercial |
$4,205.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,499.50
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$6,470.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,294.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| 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 |
$3,882.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,069.63
|
| Rate for Payer: Blue Shield of California EPN |
$3,163.83
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Cash Price |
$2,911.50
|
| Rate for Payer: Central Health Plan Commercial |
$5,176.00
|
| Rate for Payer: Cigna of CA HMO |
$4,140.80
|
| Rate for Payer: Cigna of CA PPO |
$4,787.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$5,499.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,882.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,823.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,852.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,315.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,294.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$4,852.50
|
| Rate for Payer: Networks By Design Commercial |
$4,205.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,499.50
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,882.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,882.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,235.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
IP
|
$3,345.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$669.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,676.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.00
|
| Rate for Payer: Galaxy Health WC |
$2,843.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,007.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,010.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,231.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,274.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.00
|
| Rate for Payer: Multiplan Commercial |
$2,508.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,843.25
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
OP
|
$3,345.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$12,823.92 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,823.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,843.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,839.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,839.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,007.00
|
| 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: Cash Price |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,676.00
|
| Rate for Payer: Cigna of CA PPO |
$2,475.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,843.25
|
| Rate for Payer: Dignity Health Media |
$2,843.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,843.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,338.00
|
| Rate for Payer: Galaxy Health WC |
$2,843.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,007.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,010.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,508.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,170.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,231.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.00
|
| Rate for Payer: Multiplan Commercial |
$2,508.75
|
| Rate for Payer: Networks By Design Commercial |
$2,174.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,843.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,338.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,007.00
|
| 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 Medi-Cal |
$2,843.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,843.25
|
|
|
HC REPAIR OF PROSTH HOURLY
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT L7500
|
| Hospital Charge Code |
905357500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Blue Shield of California EPN |
$26.17
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18.07
|
| Rate for Payer: United Healthcare HMO Rider |
$17.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.17
|
|
|
HC REPAIR OF PROSTH HOURLY
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT L7500
|
| Hospital Charge Code |
905357500
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.95
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.75
|
| Rate for Payer: Blue Shield of California EPN |
$26.66
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$34.30
|
| Rate for Payer: Cigna of CA PPO |
$34.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Media |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$24.50
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Riverside University Health System MISP |
$19.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.50
|
| Rate for Payer: United Healthcare All Other HMO |
$24.50
|
| Rate for Payer: United Healthcare HMO Rider |
$24.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$9,045.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,809.00 |
| Max. Negotiated Rate |
$8,140.50 |
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,236.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,618.00
|
| Rate for Payer: Galaxy Health WC |
$7,688.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,427.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,140.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,033.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,446.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,809.00
|
| Rate for Payer: Multiplan Commercial |
$6,783.75
|
| Rate for Payer: Networks By Design Commercial |
$5,879.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,688.25
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$9,045.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.22 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$5,427.00
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Cash Price |
$4,070.25
|
| Rate for Payer: Central Health Plan Commercial |
$7,236.00
|
| Rate for Payer: Cigna of CA PPO |
$6,693.30
|
| 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 |
$7,688.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,427.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,140.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,783.75
|
| 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 |
$6,033.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,809.00
|
| 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 |
$6,783.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$5,879.25
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$7,688.25
|
| 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 |
$5,427.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,522.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,522.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,522.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,522.50
|
| 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 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: Blue Shield of California EPN |
$81.70
|
| Rate for Payer: Cash Price |
$68.85
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$30.60
|
| 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: United Healthcare All Other Commercial |
$57.77
|
| Rate for Payer: United Healthcare All Other HMO |
$56.43
|
| Rate for Payer: United Healthcare HMO Rider |
$55.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.49
|
|
|
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 |
$31.29 |
| Max. Negotiated Rate |
$137.70 |
| 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 |
$84.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.39
|
| Rate for Payer: Blue Distinction Transplant |
$91.80
|
| Rate for Payer: Blue Shield of California Commercial |
$114.75
|
| Rate for Payer: Blue Shield of California EPN |
$83.23
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| 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 Media |
$130.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$114.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.55
|
| 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: LLUH Dept of Risk Management WC |
$62.73
|
| 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 |
$76.50
|
| Rate for Payer: United Healthcare All Other HMO |
$76.50
|
| Rate for Payer: United Healthcare HMO Rider |
$76.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.50
|
| 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
|
OP
|
$337.00
|
|
|
Service Code
|
CPT L4210
|
| Hospital Charge Code |
905354210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$117.95 |
| Max. Negotiated Rate |
$303.30 |
| 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 |
$185.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.10
|
| Rate for Payer: Blue Distinction Transplant |
$202.20
|
| Rate for Payer: Blue Shield of California Commercial |
$252.75
|
| Rate for Payer: Blue Shield of California EPN |
$183.33
|
| Rate for Payer: Cash Price |
$151.65
|
| 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 Media |
$286.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$252.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$117.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$224.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.17
|
| 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 |
$168.50
|
| Rate for Payer: United Healthcare All Other HMO |
$168.50
|
| Rate for Payer: United Healthcare HMO Rider |
$168.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.45
|
| Rate for Payer: Vantage Medical Group Senior |
$286.45
|
|
|
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: Blue Shield of California EPN |
$179.96
|
| Rate for Payer: Cash Price |
$151.65
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$67.40
|
| 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: United Healthcare All Other Commercial |
$127.25
|
| Rate for Payer: United Healthcare All Other HMO |
$124.29
|
| Rate for Payer: United Healthcare HMO Rider |
$121.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.21
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$14,235.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,847.00 |
| Max. Negotiated Rate |
$12,811.50 |
| Rate for Payer: Cash Price |
$6,405.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,388.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,694.00
|
| Rate for Payer: Galaxy Health WC |
$12,099.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,541.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,811.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,494.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,423.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.00
|
| Rate for Payer: Multiplan Commercial |
$10,676.25
|
| Rate for Payer: Networks By Design Commercial |
$9,252.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,099.75
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$14,235.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$405.33 |
| Max. Negotiated Rate |
$12,811.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,316.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,541.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,953.82
|
| Rate for Payer: Blue Shield of California EPN |
$6,960.92
|
| Rate for Payer: Caremore Medicare Advantage |
$7,316.90
|
| Rate for Payer: Cash Price |
$6,405.75
|
| Rate for Payer: Cash Price |
$6,405.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,388.00
|
| Rate for Payer: Cigna of CA HMO |
$9,110.40
|
| Rate for Payer: Cigna of CA PPO |
$10,533.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Galaxy Health WC |
$12,099.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,541.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,811.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,676.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12,072.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: InnovAge PACE Commercial |
$10,975.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,494.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,847.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,804.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan Commercial |
$10,676.25
|
| Rate for Payer: Networks By Design Commercial |
$9,252.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,099.75
|
| Rate for Payer: Prime Health Services Medicare |
$7,755.91
|
| Rate for Payer: Riverside University Health System MISP |
$8,048.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,541.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,541.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,117.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,117.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,117.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,117.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
