|
HC REPAIR PALATE LAC GT 2CM
|
Facility
IP
|
$14,235.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
516
|
| 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: 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
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: 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 PROFUNDUS TENDON
|
Facility
OP
|
$13,023.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,604.60 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,813.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,191.47
|
| Rate for Payer: Blue Shield of California EPN |
$6,368.25
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,418.40
|
| Rate for Payer: Cigna of CA PPO |
$9,637.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$11,069.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,813.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,720.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,767.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,686.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.60
|
| 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 |
$9,767.25
|
| Rate for Payer: Networks By Design Commercial |
$8,464.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,069.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,813.80
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,813.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,813.80
|
| 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 PROFUNDUS TENDON
|
Facility
IP
|
$13,023.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,604.60 |
| Max. Negotiated Rate |
$11,720.70 |
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,418.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,209.20
|
| Rate for Payer: Galaxy Health WC |
$11,069.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,813.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,720.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,686.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.60
|
| Rate for Payer: Multiplan Commercial |
$9,767.25
|
| Rate for Payer: Networks By Design Commercial |
$8,464.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,069.55
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
OP
|
$13,023.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,604.60 |
| Max. Negotiated Rate |
$11,720.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,813.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,191.47
|
| Rate for Payer: Blue Shield of California EPN |
$6,368.25
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,418.40
|
| Rate for Payer: Cigna of CA HMO |
$8,334.72
|
| Rate for Payer: Cigna of CA PPO |
$9,637.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$11,069.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,813.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,720.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,767.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,686.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.60
|
| 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 |
$9,767.25
|
| Rate for Payer: Networks By Design Commercial |
$8,464.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,069.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,813.80
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,813.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,813.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,511.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,511.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,511.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,511.50
|
| 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 PROFUNDUS TENDON
|
Facility
IP
|
$13,023.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$2,604.60 |
| Max. Negotiated Rate |
$11,720.70 |
| Rate for Payer: Cash Price |
$5,860.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,418.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,209.20
|
| Rate for Payer: Galaxy Health WC |
$11,069.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,813.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,720.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,686.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.60
|
| Rate for Payer: Multiplan Commercial |
$9,767.25
|
| Rate for Payer: Networks By Design Commercial |
$8,464.95
|
| Rate for Payer: Prime Health Services Commercial |
$11,069.55
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
OP
|
$932.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$196.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| 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: BCBS Transplant Transplant |
$559.20
|
| Rate for Payer: Blue Shield of California Commercial |
$586.23
|
| Rate for Payer: Blue Shield of California EPN |
$455.75
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: Cigna of CA HMO |
$596.48
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$699.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: IEHP medi-cal |
$324.84
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Innovage PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: Riverside University Health MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
IP
|
$932.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$838.80 |
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
IP
|
$932.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$838.80 |
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.80
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
OP
|
$932.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.40 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$196.87
|
| 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: BCBS Transplant Transplant |
$559.20
|
| Rate for Payer: Caremore Medicare Advantage |
$196.87
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Central Health Plan Commercial |
$745.60
|
| Rate for Payer: Cigna of CA PPO |
$689.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$265.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$196.87
|
| Rate for Payer: Galaxy Health WC |
$792.20
|
| Rate for Payer: Global Benefits Group Commercial |
$559.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$838.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$699.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$322.87
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$196.87
|
| Rate for Payer: Innovage PACE Commercial |
$295.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$621.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$196.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$263.81
|
| Rate for Payer: Multiplan Commercial |
$699.00
|
| Rate for Payer: Networks By Design Commercial |
$605.80
|
| Rate for Payer: Prime Health Services Commercial |
$792.20
|
| Rate for Payer: Prime Health Services Medicare |
$208.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$559.20
|
| Rate for Payer: Riverside University Health MISP |
$216.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$559.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.00
|
| Rate for Payer: United Healthcare All Other HMO |
$466.00
|
| Rate for Payer: United Healthcare HMO Rider |
$466.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
IP
|
$6,726.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,345.20 |
| Max. Negotiated Rate |
$6,053.40 |
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.40
|
| Rate for Payer: Galaxy Health WC |
$5,717.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,053.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,486.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.20
|
| Rate for Payer: Multiplan Commercial |
$5,044.50
|
| Rate for Payer: Networks By Design Commercial |
$4,371.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,717.10
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
OP
|
$6,726.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,035.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.80
|
| Rate for Payer: Cigna of CA PPO |
$4,977.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,717.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,053.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,044.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,486.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.20
|
| 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 |
$5,044.50
|
| Rate for Payer: Networks By Design Commercial |
$4,371.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,717.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,035.60
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,363.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,363.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,363.00
|
| 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 TENDON EXTENSOR FOOT EA
|
Facility
IP
|
$6,726.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,345.20 |
| Max. Negotiated Rate |
$6,053.40 |
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.40
|
| Rate for Payer: Galaxy Health WC |
$5,717.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,053.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,486.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.20
|
| Rate for Payer: Multiplan Commercial |
$5,044.50
|
| Rate for Payer: Networks By Design Commercial |
$4,371.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,717.10
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
OP
|
$6,726.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,345.20 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,044.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,035.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,289.01
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Cash Price |
$3,026.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,380.80
|
| Rate for Payer: Cigna of CA HMO |
$4,304.64
|
| Rate for Payer: Cigna of CA PPO |
$4,977.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,717.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,053.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,044.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$6,672.95
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,486.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,345.20
|
| 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 |
$5,044.50
|
| Rate for Payer: Networks By Design Commercial |
$4,371.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,717.10
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,035.60
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,035.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,363.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,363.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,363.00
|
| 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 TENDON,LEG PRIM W/O GRF
|
Facility
OP
|
$8,189.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,370.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,913.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,551.20
|
| Rate for Payer: Cigna of CA PPO |
$6,059.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,960.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,913.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,370.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,141.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,637.80
|
| 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 |
$6,141.75
|
| Rate for Payer: Networks By Design Commercial |
$5,322.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,960.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,913.40
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,913.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,094.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,094.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,094.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,094.50
|
| 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 TENDON,LEG PRIM W/O GRF
|
Facility
IP
|
$8,189.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,637.80 |
| Max. Negotiated Rate |
$7,370.10 |
| Rate for Payer: Blue Shield of California Commercial |
$6,141.75
|
| Rate for Payer: Cash Price |
$3,685.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,551.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,275.60
|
| Rate for Payer: Galaxy Health WC |
$6,960.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,913.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,370.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,462.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,637.80
|
| Rate for Payer: Multiplan Commercial |
$6,141.75
|
| Rate for Payer: Networks By Design Commercial |
$5,322.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,960.65
|
|
|
HC REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
OP
|
$8,156.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,893.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,524.80
|
| Rate for Payer: Cigna of CA PPO |
$6,035.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$6,932.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,893.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,340.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,117.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Innovage PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,440.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$6,117.00
|
| Rate for Payer: Networks By Design Commercial |
$5,301.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,932.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,893.60
|
| Rate for Payer: Riverside University Health MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,893.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,078.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,078.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,078.00
|
| 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 TENDON/MUSCLE PRIM SNGL
|
Facility
IP
|
$8,156.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,631.20 |
| Max. Negotiated Rate |
$7,340.40 |
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Central Health Plan Commercial |
$6,524.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,262.40
|
| Rate for Payer: Galaxy Health WC |
$6,932.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,893.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,340.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,440.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,631.20
|
| Rate for Payer: Multiplan Commercial |
$6,117.00
|
| Rate for Payer: Networks By Design Commercial |
$5,301.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,932.60
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
OP
|
$3,289.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$305.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,973.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,068.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,608.32
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,631.20
|
| Rate for Payer: Cigna of CA HMO |
$2,104.96
|
| Rate for Payer: Cigna of CA PPO |
$2,433.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| 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 |
$2,795.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,973.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,960.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,466.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: IEHP medi-cal |
$503.56
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Innovage PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.80
|
| 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 |
$2,466.75
|
| Rate for Payer: Networks By Design Commercial |
$2,137.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,973.40
|
| Rate for Payer: Riverside University Health MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,973.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,973.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,644.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,644.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,644.50
|
| 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 TONGUE LACERATION GT 2.6C
|
Facility
IP
|
$3,289.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$657.80 |
| Max. Negotiated Rate |
$2,960.10 |
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,631.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.60
|
| Rate for Payer: Galaxy Health WC |
$2,795.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,973.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,960.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.80
|
| Rate for Payer: Multiplan Commercial |
$2,466.75
|
| Rate for Payer: Networks By Design Commercial |
$2,137.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,795.65
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
OP
|
$3,289.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,973.40
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,631.20
|
| Rate for Payer: Cigna of CA PPO |
$2,433.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| 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 |
$2,795.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,973.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,960.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,466.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Innovage PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.80
|
| 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 |
$2,466.75
|
| Rate for Payer: Networks By Design Commercial |
$2,137.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,795.65
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,973.40
|
| Rate for Payer: Riverside University Health MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,973.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,644.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,644.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,644.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,644.50
|
| 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 TONGUE LACERATION GT 2.6C
|
Facility
IP
|
$3,289.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$657.80 |
| Max. Negotiated Rate |
$2,960.10 |
| Rate for Payer: Cash Price |
$1,480.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,631.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,315.60
|
| Rate for Payer: Galaxy Health WC |
$2,795.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,973.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,960.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,193.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$657.80
|
| Rate for Payer: Multiplan Commercial |
$2,466.75
|
| Rate for Payer: Networks By Design Commercial |
$2,137.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,795.65
|
|
|
HC REPAIR TUNNEL NON TUNNEL CV CATH
|
Facility
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945000113
|
|
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: 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 TUNNEL NON TUNNEL CV CATH
|
Facility
OP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
945000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.40 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$2,562.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,287.24
|
| Rate for Payer: IEHP medi-cal |
$1,295.08
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$2,050.20
|
| Rate for Payer: Riverside University Health 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 TUNNEL NON TUNNEL CV CATH
|
Facility
IP
|
$3,417.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
948100113
|
|
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: 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
|
|
