|
HC CL TREAT HIP DISC TR W/ANESTH
|
Facility
|
IP
|
$4,486.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
900501083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,076.64 |
| Max. Negotiated Rate |
$3,813.10 |
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.40
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.64
|
| Rate for Payer: Multiplan Commercial |
$3,588.80
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
|
|
HC CL TREAT HIP DISC TR W/O ANEST
|
Facility
|
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
900501228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$997.80
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cigna of CA PPO |
$1,230.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,247.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,109.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$831.50
|
| Rate for Payer: United Healthcare All Other HMO |
$831.50
|
| Rate for Payer: United Healthcare HMO Rider |
$831.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$831.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT HIP DISC TR W/O ANEST
|
Facility
|
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
900501228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.12 |
| Max. Negotiated Rate |
$1,413.55 |
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.20
|
| Rate for Payer: Galaxy Health WC |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,109.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| Rate for Payer: Multiplan Commercial |
$1,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
|
|
HC CL TREAT HUMERAL FRAC W/O MANI
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
900501326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,019.40
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cigna of CA PPO |
$1,257.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,274.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,019.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$849.50
|
| Rate for Payer: United Healthcare All Other HMO |
$849.50
|
| Rate for Payer: United Healthcare HMO Rider |
$849.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$849.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT HUMERAL FRAC W/O MANI
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
900501326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$407.76 |
| Max. Negotiated Rate |
$1,444.15 |
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.60
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$647.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.76
|
| Rate for Payer: Multiplan Commercial |
$1,359.20
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
|
|
HC CL TREAT HUMERAL FX W/MANIPULA
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
900501497
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
|
|
HC CL TREAT HUMERAL FX W/MANIPULA
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
900501497
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.75 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,823.40
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA PPO |
$2,248.86
|
| 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 |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,279.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,519.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,519.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,519.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,519.50
|
| 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 CL TREAT HUMERAL SHAFT FX W/O
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
900501520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC CL TREAT HUMERAL SHAFT FX W/O
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
900501520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.00
|
| Rate for Payer: United Healthcare All Other HMO |
$804.00
|
| Rate for Payer: United Healthcare HMO Rider |
$804.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT HUMERUS FX W/MANIPULA
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
900501365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$511.42 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,823.40
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA PPO |
$2,248.86
|
| 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 |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,279.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,519.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,519.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,519.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,519.50
|
| 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 CL TREAT HUMERUS FX W/MANIPULA
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
900501365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
|
|
HC CL TREAT HUMERUS FX W/O MANIPU
|
Facility
|
IP
|
$1,492.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
900501566
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$358.08 |
| Max. Negotiated Rate |
$1,268.20 |
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.80
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
|
|
HC CL TREAT HUMERUS FX W/O MANIPU
|
Facility
|
OP
|
$1,492.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
900501566
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.29 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$895.20
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,119.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| Rate for Payer: United Healthcare All Other HMO |
$746.00
|
| Rate for Payer: United Healthcare HMO Rider |
$746.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$746.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT INTPHAL JOINT SIN W/A
|
Facility
|
OP
|
$6,215.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
900501080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.55 |
| Max. Negotiated Rate |
$5,282.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,729.00
|
| Rate for Payer: Cash Price |
$2,796.75
|
| Rate for Payer: Cash Price |
$2,796.75
|
| Rate for Payer: Cash Price |
$2,796.75
|
| Rate for Payer: Cigna of CA PPO |
$4,599.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$5,282.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,729.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,661.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,145.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$4,972.00
|
| Rate for Payer: Networks By Design Commercial |
$4,039.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,282.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,729.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,107.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,107.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,107.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,107.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC CL TREAT INTPHAL JOINT SIN W/A
|
Facility
|
IP
|
$6,215.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
900501080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,491.60 |
| Max. Negotiated Rate |
$5,282.75 |
| Rate for Payer: Cash Price |
$2,796.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,486.00
|
| Rate for Payer: Galaxy Health WC |
$5,282.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,145.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,367.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,491.60
|
| Rate for Payer: Multiplan Commercial |
$4,972.00
|
| Rate for Payer: Networks By Design Commercial |
$4,039.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,282.75
|
|
|
HC CL TREAT KNEE FRACTURES
|
Facility
|
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
900501533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.60 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,016.40
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: Cigna of CA PPO |
$1,253.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,439.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,016.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,270.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: Networks By Design Commercial |
$1,101.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,016.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$847.00
|
| Rate for Payer: United Healthcare All Other HMO |
$847.00
|
| Rate for Payer: United Healthcare HMO Rider |
$847.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$847.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT KNEE FRACTURES
|
Facility
|
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
900501533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$1,439.90 |
| Rate for Payer: Blue Shield of California Commercial |
$1,206.13
|
| Rate for Payer: Blue Shield of California EPN |
$867.33
|
| Rate for Payer: Cash Price |
$762.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$677.60
|
| Rate for Payer: Galaxy Health WC |
$1,439.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,016.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,129.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$645.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.56
|
| Rate for Payer: Multiplan Commercial |
$1,355.20
|
| Rate for Payer: Networks By Design Commercial |
$1,101.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,439.90
|
|
|
HC CL TREAT LUNATE DISLOCA W/MANI
|
Facility
|
IP
|
$6,316.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
900501383
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,515.84 |
| Max. Negotiated Rate |
$5,368.60 |
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,526.40
|
| Rate for Payer: Galaxy Health WC |
$5,368.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,789.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,406.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,515.84
|
| Rate for Payer: Multiplan Commercial |
$5,052.80
|
| Rate for Payer: Networks By Design Commercial |
$4,105.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,368.60
|
|
|
HC CL TREAT LUNATE DISLOCA W/MANI
|
Facility
|
OP
|
$6,316.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
900501383
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.69 |
| Max. Negotiated Rate |
$5,368.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,789.60
|
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Cigna of CA PPO |
$4,673.84
|
| 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 |
$5,368.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,789.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,737.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,515.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$5,052.80
|
| Rate for Payer: Networks By Design Commercial |
$4,105.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,368.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,158.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,158.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,158.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,158.00
|
| 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 CL TREAT MANDIBULAR FX
|
Facility
|
IP
|
$15,733.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
900501369
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,775.92 |
| Max. Negotiated Rate |
$13,373.05 |
| Rate for Payer: Cash Price |
$7,079.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,293.20
|
| Rate for Payer: Galaxy Health WC |
$13,373.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,439.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,493.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,994.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,775.92
|
| Rate for Payer: Multiplan Commercial |
$12,586.40
|
| Rate for Payer: Networks By Design Commercial |
$10,226.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,373.05
|
|
|
HC CL TREAT MANDIBULAR FX
|
Facility
|
OP
|
$15,733.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
900501369
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$13,373.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,439.80
|
| Rate for Payer: Cash Price |
$7,079.85
|
| Rate for Payer: Cash Price |
$7,079.85
|
| Rate for Payer: Cash Price |
$7,079.85
|
| Rate for Payer: Cigna of CA PPO |
$11,642.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Media |
$7,316.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,877.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,316.90
|
| Rate for Payer: Galaxy Health WC |
$13,373.05
|
| Rate for Payer: Global Benefits Group Commercial |
$9,439.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,799.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,999.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,999.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,493.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,316.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,775.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,804.65
|
| Rate for Payer: Multiplan Commercial |
$12,586.40
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: Networks By Design Commercial |
$10,226.45
|
| Rate for Payer: Prime Health Services Commercial |
$13,373.05
|
| Rate for Payer: Prime Health Services WC |
$9,901.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,439.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,866.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,866.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,866.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
|
OP
|
$15,657.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$720.10 |
| Max. Negotiated Rate |
$13,308.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,394.20
|
| Rate for Payer: Cash Price |
$7,045.65
|
| Rate for Payer: Cash Price |
$7,045.65
|
| Rate for Payer: Cash Price |
$7,045.65
|
| Rate for Payer: Cigna of CA PPO |
$11,586.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$13,308.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,394.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,742.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,443.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,757.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$12,525.60
|
| Rate for Payer: Networks By Design Commercial |
$10,177.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,308.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,828.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,828.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,828.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,828.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
|
IP
|
$15,657.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,757.68 |
| Max. Negotiated Rate |
$13,308.45 |
| Rate for Payer: Cash Price |
$7,045.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,262.80
|
| Rate for Payer: Galaxy Health WC |
$13,308.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,443.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,965.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,757.68
|
| Rate for Payer: Multiplan Commercial |
$12,525.60
|
| Rate for Payer: Networks By Design Commercial |
$10,177.05
|
| Rate for Payer: Prime Health Services Commercial |
$13,308.45
|
|
|
HC CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
|
OP
|
$7,351.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.53 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,410.60
|
| Rate for Payer: Cash Price |
$3,307.95
|
| Rate for Payer: Cash Price |
$3,307.95
|
| Rate for Payer: Cash Price |
$3,307.95
|
| Rate for Payer: Cigna of CA PPO |
$5,439.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,248.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,410.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,513.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,903.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,764.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,880.80
|
| Rate for Payer: Networks By Design Commercial |
$4,778.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,248.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,410.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,675.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,675.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,675.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,675.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
|
IP
|
$7,351.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,764.24 |
| Max. Negotiated Rate |
$6,248.35 |
| Rate for Payer: Cash Price |
$3,307.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,940.40
|
| Rate for Payer: Galaxy Health WC |
$6,248.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,410.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,903.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,800.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,764.24
|
| Rate for Payer: Multiplan Commercial |
$5,880.80
|
| Rate for Payer: Networks By Design Commercial |
$4,778.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,248.35
|
|
