|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.60 |
| 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 |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,120.80
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA PPO |
$1,382.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,401.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$1,214.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.00
|
| Rate for Payer: United Healthcare All Other HMO |
$934.00
|
| Rate for Payer: United Healthcare HMO Rider |
$934.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$1,427.40 |
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$634.40
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,427.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$604.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.20
|
| Rate for Payer: Multiplan Commercial |
$1,189.50
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.20 |
| 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 |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$951.60
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.80
|
| Rate for Payer: Cigna of CA PPO |
$1,173.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,427.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,189.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,189.50
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$951.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$793.00
|
| Rate for Payer: United Healthcare All Other HMO |
$793.00
|
| Rate for Payer: United Healthcare HMO Rider |
$793.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$793.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$951.60
|
| Rate for Payer: Blue Shield of California Commercial |
$997.59
|
| Rate for Payer: Blue Shield of California EPN |
$775.55
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.80
|
| Rate for Payer: Cigna of CA HMO |
$1,015.04
|
| Rate for Payer: Cigna of CA PPO |
$1,173.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,427.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,189.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,189.50
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$951.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$951.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$793.00
|
| Rate for Payer: United Healthcare All Other HMO |
$793.00
|
| Rate for Payer: United Healthcare HMO Rider |
$793.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$793.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$1,427.40 |
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$634.40
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,427.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$604.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.20
|
| Rate for Payer: Multiplan Commercial |
$1,189.50
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
IP
|
$2,642.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$528.40 |
| Max. Negotiated Rate |
$2,377.80 |
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,056.80
|
| Rate for Payer: Galaxy Health WC |
$2,245.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,377.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,006.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.40
|
| Rate for Payer: Multiplan Commercial |
$1,981.50
|
| Rate for Payer: Networks By Design Commercial |
$1,717.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,245.70
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
OP
|
$2,642.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
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 |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,585.20
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Cash Price |
$1,188.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,113.60
|
| Rate for Payer: Cigna of CA PPO |
$1,955.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$2,245.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,585.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,377.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,981.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,762.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,981.50
|
| Rate for Payer: Networks By Design Commercial |
$1,717.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,245.70
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,585.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,321.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,321.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,321.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,321.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$932.80
|
| 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 |
$1,017.60
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Media |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,272.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Riverside University Health System MISP |
$678.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$339.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$932.80
|
| 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 |
$1,017.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,066.78
|
| Rate for Payer: Blue Shield of California EPN |
$829.34
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.80
|
| Rate for Payer: Cigna of CA HMO |
$1,085.44
|
| Rate for Payer: Cigna of CA PPO |
$1,255.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,441.60
|
| Rate for Payer: Dignity Health Media |
$1,441.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,441.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$678.40
|
| Rate for Payer: Galaxy Health WC |
$1,441.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,526.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,272.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$593.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.20
|
| Rate for Payer: Multiplan Commercial |
$1,272.00
|
| Rate for Payer: Networks By Design Commercial |
$1,102.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,441.60
|
| Rate for Payer: Riverside University Health System MISP |
$678.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,017.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,017.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.00
|
| Rate for Payer: United Healthcare All Other HMO |
$848.00
|
| Rate for Payer: United Healthcare HMO Rider |
$848.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,441.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,441.60
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$800.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$800.25
|
| 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 |
$873.00
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.00
|
| Rate for Payer: Cigna of CA PPO |
$1,076.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,236.75
|
| Rate for Payer: Dignity Health Media |
$1,236.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,236.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,091.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Riverside University Health System MISP |
$582.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$727.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,236.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,236.75
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,309.50 |
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,309.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.00
|
| Rate for Payer: Multiplan Commercial |
$1,091.25
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.60 |
| Max. Negotiated Rate |
$1,802.70 |
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,602.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.20
|
| Rate for Payer: Galaxy Health WC |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,802.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$763.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.60
|
| Rate for Payer: Multiplan Commercial |
$1,502.25
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,702.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,101.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,101.65
|
| 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 |
$1,201.80
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Cash Price |
$901.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,602.40
|
| Rate for Payer: Cigna of CA PPO |
$1,482.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,702.55
|
| Rate for Payer: Dignity Health Media |
$1,702.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,702.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$801.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$801.20
|
| Rate for Payer: Galaxy Health WC |
$1,702.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,201.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,802.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,502.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,336.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.60
|
| Rate for Payer: Multiplan Commercial |
$1,502.25
|
| Rate for Payer: Networks By Design Commercial |
$1,301.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,702.55
|
| Rate for Payer: Riverside University Health System MISP |
$801.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,201.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,001.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,001.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,001.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,001.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,702.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,702.55
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
OP
|
$7,036.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$4,221.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$3,166.20
|
| Rate for Payer: Cash Price |
$3,166.20
|
| Rate for Payer: Cash Price |
$3,166.20
|
| Rate for Payer: Cash Price |
$3,166.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,628.80
|
| Rate for Payer: Cigna of CA PPO |
$5,206.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$5,980.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,221.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,332.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,277.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,693.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$567.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$5,277.00
|
| Rate for Payer: Networks By Design Commercial |
$4,573.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,980.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,518.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,518.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,518.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
IP
|
$7,036.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,407.20 |
| Max. Negotiated Rate |
$6,332.40 |
| Rate for Payer: Cash Price |
$3,166.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,628.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,814.40
|
| Rate for Payer: Galaxy Health WC |
$5,980.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,221.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,332.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,693.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,680.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.20
|
| Rate for Payer: Multiplan Commercial |
$5,277.00
|
| Rate for Payer: Networks By Design Commercial |
$4,573.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,980.60
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$8,868.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
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: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$5,320.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,094.40
|
| Rate for Payer: Cigna of CA PPO |
$6,562.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$7,537.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,320.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,981.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,651.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,914.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$6,651.00
|
| Rate for Payer: Networks By Design Commercial |
$5,764.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,537.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,320.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,434.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$8,868.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,773.60 |
| Max. Negotiated Rate |
$7,981.20 |
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,094.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,547.20
|
| Rate for Payer: Galaxy Health WC |
$7,537.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,320.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,981.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,914.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,378.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.60
|
| Rate for Payer: Multiplan Commercial |
$6,651.00
|
| Rate for Payer: Networks By Design Commercial |
$5,764.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,537.80
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$8,868.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$556.70 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$5,320.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,577.97
|
| Rate for Payer: Blue Shield of California EPN |
$4,336.45
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,094.40
|
| Rate for Payer: Cigna of CA HMO |
$5,675.52
|
| Rate for Payer: Cigna of CA PPO |
$6,562.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$7,537.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,320.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,981.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,651.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,313.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,914.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$6,651.00
|
| Rate for Payer: Networks By Design Commercial |
$5,764.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,537.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,320.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,320.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,434.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$8,868.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,773.60 |
| Max. Negotiated Rate |
$7,981.20 |
| Rate for Payer: Cash Price |
$3,990.60
|
| Rate for Payer: Central Health Plan Commercial |
$7,094.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,547.20
|
| Rate for Payer: Galaxy Health WC |
$7,537.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,320.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,981.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,914.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,378.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.60
|
| Rate for Payer: Multiplan Commercial |
$6,651.00
|
| Rate for Payer: Networks By Design Commercial |
$5,764.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,537.80
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.08 |
| 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 |
$1,522.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$985.05
|
| 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 |
$1,074.60
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.80
|
| Rate for Payer: Cigna of CA PPO |
$1,325.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Dignity Health Media |
$1,522.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,522.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,343.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.20
|
| Rate for Payer: Multiplan Commercial |
$1,343.25
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
| Rate for Payer: Riverside University Health System MISP |
$716.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,074.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.50
|
| Rate for Payer: United Healthcare All Other HMO |
$895.50
|
| Rate for Payer: United Healthcare HMO Rider |
$895.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,522.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,522.35
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Cash Price |
$805.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.20
|
| Rate for Payer: Multiplan Commercial |
$1,343.25
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
IP
|
$12,995.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,599.00 |
| Max. Negotiated Rate |
$11,695.50 |
| Rate for Payer: Cash Price |
$5,847.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,396.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,198.00
|
| Rate for Payer: Galaxy Health WC |
$11,045.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,797.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,695.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,667.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,951.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,599.00
|
| Rate for Payer: Multiplan Commercial |
$9,746.25
|
| Rate for Payer: Networks By Design Commercial |
$8,446.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,045.75
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
OP
|
$12,995.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,323.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,797.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,173.86
|
| Rate for Payer: Blue Shield of California EPN |
$6,354.56
|
| Rate for Payer: Caremore Medicare Advantage |
$8,323.04
|
| Rate for Payer: Cash Price |
$5,847.75
|
| Rate for Payer: Cash Price |
$5,847.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,396.00
|
| Rate for Payer: Cigna of CA PPO |
$9,616.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$11,045.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,797.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,695.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,746.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,649.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13,733.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: InnovAge PACE Commercial |
$12,484.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,667.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,599.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,152.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$9,746.25
|
| Rate for Payer: Networks By Design Commercial |
$8,446.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,045.75
|
| Rate for Payer: Prime Health Services Medicare |
$8,822.42
|
| Rate for Payer: Riverside University Health System MISP |
$9,155.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,797.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,797.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
