|
HC CL TREAT POST HIP ARTHOPLAS
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
900501084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,194.72 |
| Max. Negotiated Rate |
$4,231.30 |
| Rate for Payer: Cash Price |
$2,240.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,991.20
|
| Rate for Payer: Galaxy Health WC |
$4,231.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,986.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,320.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,896.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,194.72
|
| Rate for Payer: Multiplan Commercial |
$3,982.40
|
| Rate for Payer: Networks By Design Commercial |
$3,235.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,231.30
|
|
|
HC CL TREAT POST HIP ARTH W/O ANE
|
Facility
|
IP
|
$1,552.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$372.48 |
| Max. Negotiated Rate |
$1,319.20 |
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.80
|
| Rate for Payer: Galaxy Health WC |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$591.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.48
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: Networks By Design Commercial |
$1,008.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
|
|
HC CL TREAT POST HIP ARTH W/O ANE
|
Facility
|
OP
|
$1,552.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
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 |
$931.20
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna of CA PPO |
$1,148.48
|
| 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 |
$1,319.20
|
| Rate for Payer: Global Benefits Group Commercial |
$931.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,164.00
|
| 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 |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.48
|
| 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 |
$1,241.60
|
| Rate for Payer: Networks By Design Commercial |
$1,008.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,319.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$931.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$776.00
|
| Rate for Payer: United Healthcare All Other HMO |
$776.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$776.00
|
| 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 PROXIMAL HUMERAL FX
|
Facility
|
OP
|
$1,823.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
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 |
$1,093.80
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cigna of CA PPO |
$1,349.02
|
| 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 |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,367.25
|
| 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 |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.52
|
| 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 |
$1,458.40
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$911.50
|
| Rate for Payer: United Healthcare All Other HMO |
$911.50
|
| Rate for Payer: United Healthcare HMO Rider |
$911.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$911.50
|
| 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 PROXIMAL HUMERAL FX
|
Facility
|
IP
|
$1,823.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$437.52 |
| Max. Negotiated Rate |
$1,549.55 |
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.20
|
| Rate for Payer: Galaxy Health WC |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.52
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
|
|
HC CL TREAT RADIAL HEAD/NECK FX
|
Facility
|
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.68 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
|
|
HC CL TREAT RADIAL HEAD/NECK FX
|
Facility
|
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
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 |
$1,069.20
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna of CA PPO |
$1,318.68
|
| 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 |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,336.50
|
| 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 |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| 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 |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$891.00
|
| Rate for Payer: United Healthcare All Other HMO |
$891.00
|
| Rate for Payer: United Healthcare HMO Rider |
$891.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$891.00
|
| 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 RADIAL SHAFT FRX W/DI
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.08 |
| 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 |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cigna of CA PPO |
$1,858.14
|
| 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 |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,883.25
|
| 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 |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| 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 |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,506.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,255.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,255.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,255.50
|
| 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 RADIAL SHAFT FRX W/DI
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.40
|
| Rate for Payer: Galaxy Health WC |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
|
|
HC CL TREAT RADIAL SHAFT FX W/O M
|
Facility
|
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
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 |
$1,205.40
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| 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 |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,506.75
|
| 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 |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| 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 |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,004.50
|
| 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 RADIAL SHAFT FX W/O M
|
Facility
|
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC CL TREAT RADIOULNAR DIS W/MANI
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$411.60 |
| Max. Negotiated Rate |
$1,457.75 |
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$686.00
|
| Rate for Payer: Galaxy Health WC |
$1,457.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,029.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$653.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.60
|
| Rate for Payer: Multiplan Commercial |
$1,372.00
|
| Rate for Payer: Networks By Design Commercial |
$1,114.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,457.75
|
|
|
HC CL TREAT RADIOULNAR DIS W/MANI
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
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 |
$1,029.00
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cash Price |
$771.75
|
| Rate for Payer: Cigna of CA PPO |
$1,269.10
|
| 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 |
$1,457.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,029.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,286.25
|
| 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 |
$1,143.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$436.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.60
|
| 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 |
$1,372.00
|
| Rate for Payer: Networks By Design Commercial |
$1,114.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,457.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,029.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$857.50
|
| Rate for Payer: United Healthcare All Other HMO |
$857.50
|
| Rate for Payer: United Healthcare HMO Rider |
$857.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$857.50
|
| 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 RADIUS/ULNA FX,W/O MA
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$5,938.00 |
| 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 |
$5,938.00
|
| 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 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 RADIUS/ULNA FX,W/O MA
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
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 RAD SHAFT FRX W/MANIP
|
Facility
|
OP
|
$3,218.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.17 |
| 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 |
$1,930.80
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: Cigna of CA PPO |
$2,381.32
|
| 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 |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,413.50
|
| 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 |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.32
|
| 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 |
$2,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,930.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,609.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,609.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,609.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,609.00
|
| 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 RAD SHAFT FRX W/MANIP
|
Facility
|
IP
|
$3,218.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$772.32 |
| Max. Negotiated Rate |
$2,735.30 |
| Rate for Payer: Cash Price |
$1,448.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,287.20
|
| Rate for Payer: Galaxy Health WC |
$2,735.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,930.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,146.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,226.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$772.32
|
| Rate for Payer: Multiplan Commercial |
$2,574.40
|
| Rate for Payer: Networks By Design Commercial |
$2,091.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,735.30
|
|
|
HC CL TREAT SCAPULAR FX, W/O MANI
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.00 |
| 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 |
$1,181.40
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA PPO |
$1,457.06
|
| 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 |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,476.75
|
| 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 |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| 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 |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$984.50
|
| Rate for Payer: United Healthcare All Other HMO |
$984.50
|
| Rate for Payer: United Healthcare HMO Rider |
$984.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.50
|
| 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 SCAPULAR FX, W/O MANI
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
|
|
HC CL TREAT SC/TC HMRL FX W/MANIP
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$912.00 |
| 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 |
$2,280.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna of CA PPO |
$2,812.00
|
| 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 |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,850.00
|
| 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 |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.00
|
| 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 |
$3,040.00
|
| Rate for Payer: Networks By Design Commercial |
$2,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,900.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,900.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,900.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,900.00
|
| 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 SC/TC HMRL FX W/MANIP
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$912.00 |
| Max. Negotiated Rate |
$3,230.00 |
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.00
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,447.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$3,040.00
|
| Rate for Payer: Networks By Design Commercial |
$2,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
|
|
HC CL TREAT SHLDR DISLOC W/ANES
|
Facility
|
IP
|
$7,488.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,797.12 |
| Max. Negotiated Rate |
$6,364.80 |
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,995.20
|
| Rate for Payer: Galaxy Health WC |
$6,364.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,492.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,994.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,852.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,797.12
|
| Rate for Payer: Multiplan Commercial |
$5,990.40
|
| Rate for Payer: Networks By Design Commercial |
$4,867.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,364.80
|
|
|
HC CL TREAT SHLDR DISLOC W/ANES
|
Facility
|
OP
|
$7,488.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$6,364.80 |
| 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 |
$4,492.80
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cash Price |
$3,369.60
|
| Rate for Payer: Cigna of CA PPO |
$5,541.12
|
| 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 |
$6,364.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,492.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,616.00
|
| 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 |
$4,994.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,797.12
|
| 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 |
$5,990.40
|
| Rate for Payer: Networks By Design Commercial |
$4,867.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,364.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,492.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,744.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,744.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,744.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,744.00
|
| 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 SHLDR DISLO/FX W/MANI
|
Facility
|
OP
|
$3,800.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
900501501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$912.00 |
| 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 |
$2,280.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: Cigna of CA PPO |
$2,812.00
|
| 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 |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,850.00
|
| 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 |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.00
|
| 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 |
$3,040.00
|
| Rate for Payer: Networks By Design Commercial |
$2,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,280.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,900.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,900.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,900.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,900.00
|
| 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 SHLDR DISLO/FX W/MANI
|
Facility
|
IP
|
$3,800.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
900501501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$912.00 |
| Max. Negotiated Rate |
$3,230.00 |
| Rate for Payer: Cash Price |
$1,710.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,520.00
|
| Rate for Payer: Galaxy Health WC |
$3,230.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,280.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,534.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,447.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$3,040.00
|
| Rate for Payer: Networks By Design Commercial |
$2,470.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,230.00
|
|
