|
HC CL TREAT TRIMALLOR FX W/MANIPU
|
Facility
|
IP
|
$4,378.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
900501094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,050.72 |
| Max. Negotiated Rate |
$3,721.30 |
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,751.20
|
| Rate for Payer: Galaxy Health WC |
$3,721.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,920.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,668.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.72
|
| Rate for Payer: Multiplan Commercial |
$3,502.40
|
| Rate for Payer: Networks By Design Commercial |
$2,845.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,721.30
|
|
|
HC CL TREAT TROCHANTERIC FX WO MAN
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
900527246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.56 |
| 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 |
$596.40
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cigna of CA PPO |
$735.56
|
| 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 |
$844.90
|
| Rate for Payer: Global Benefits Group Commercial |
$596.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$745.50
|
| 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 |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.56
|
| 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 |
$795.20
|
| Rate for Payer: Networks By Design Commercial |
$646.10
|
| Rate for Payer: Prime Health Services Commercial |
$844.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$596.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.00
|
| Rate for Payer: United Healthcare All Other HMO |
$497.00
|
| Rate for Payer: United Healthcare HMO Rider |
$497.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.00
|
| 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 TROCHANTERIC FX WO MAN
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
900527246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.56 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.60
|
| Rate for Payer: Galaxy Health WC |
$844.90
|
| Rate for Payer: Global Benefits Group Commercial |
$596.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.56
|
| Rate for Payer: Multiplan Commercial |
$795.20
|
| Rate for Payer: Networks By Design Commercial |
$646.10
|
| Rate for Payer: Prime Health Services Commercial |
$844.90
|
|
|
HC CL TREAT ULNAR FX,PROXIMAL END
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
900501467
|
|
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 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 ULNAR FX,PROXIMAL END
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
900501467
|
|
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 ULNAR FX, W/MANIPULAT
|
Facility
|
IP
|
$2,100.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,785.00 |
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$840.00
|
| Rate for Payer: Galaxy Health WC |
$1,785.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,260.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,400.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$800.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.00
|
| Rate for Payer: Multiplan Commercial |
$1,680.00
|
| Rate for Payer: Networks By Design Commercial |
$1,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,785.00
|
|
|
HC CL TREAT ULNAR FX, W/MANIPULAT
|
Facility
|
OP
|
$2,100.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.54 |
| 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 |
$1,260.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cash Price |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$1,554.00
|
| 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 |
$1,785.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,260.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,575.00
|
| 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 |
$1,400.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.00
|
| 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 |
$1,680.00
|
| Rate for Payer: Networks By Design Commercial |
$1,365.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,785.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,050.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,050.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,050.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,050.00
|
| 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 ULNAR SHAFT FX W/MANI
|
Facility
|
OP
|
$1,995.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
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 |
$1,197.00
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: Cigna of CA PPO |
$1,476.30
|
| 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 |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,496.25
|
| 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 |
$1,330.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.80
|
| 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 |
$1,596.00
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,197.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$997.50
|
| Rate for Payer: United Healthcare All Other HMO |
$997.50
|
| Rate for Payer: United Healthcare HMO Rider |
$997.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$997.50
|
| 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 ULNAR SHAFT FX W/MANI
|
Facility
|
IP
|
$1,995.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$1,695.75 |
| Rate for Payer: Cash Price |
$897.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$798.00
|
| Rate for Payer: Galaxy Health WC |
$1,695.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,197.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,330.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$760.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$1,596.00
|
| Rate for Payer: Networks By Design Commercial |
$1,296.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,695.75
|
|
|
HC CL TREAT ULNAR STYLOID FX
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
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 ULNAR STYLOID FX
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$590.65
|
| 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 VERTEBRAL BODY FX W/O
|
Facility
|
OP
|
$1,411.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.34 |
| 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 |
$846.60
|
| Rate for Payer: Cash Price |
$634.95
|
| Rate for Payer: Cash Price |
$634.95
|
| Rate for Payer: Cash Price |
$634.95
|
| Rate for Payer: Cigna of CA PPO |
$1,044.14
|
| 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 |
$1,199.35
|
| Rate for Payer: Global Benefits Group Commercial |
$846.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,058.25
|
| 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 |
$941.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.64
|
| 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 |
$1,128.80
|
| Rate for Payer: Networks By Design Commercial |
$917.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,199.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$846.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$705.50
|
| Rate for Payer: United Healthcare All Other HMO |
$705.50
|
| Rate for Payer: United Healthcare HMO Rider |
$705.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$705.50
|
| 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 VERTEBRAL BODY FX W/O
|
Facility
|
IP
|
$1,411.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$338.64 |
| Max. Negotiated Rate |
$1,199.35 |
| Rate for Payer: Cash Price |
$634.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$564.40
|
| Rate for Payer: Galaxy Health WC |
$1,199.35
|
| Rate for Payer: Global Benefits Group Commercial |
$846.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$941.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$537.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.64
|
| Rate for Payer: Multiplan Commercial |
$1,128.80
|
| Rate for Payer: Networks By Design Commercial |
$917.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,199.35
|
|
|
HC CL TREAT WRIST FX, W/MANIPULAT
|
Facility
|
OP
|
$1,785.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.20 |
| 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 |
$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 |
$1,071.00
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cigna of CA PPO |
$1,320.90
|
| 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 |
$1,517.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,338.75
|
| 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 |
$1,190.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| 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 |
$1,428.00
|
| Rate for Payer: Networks By Design Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,517.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$892.50
|
| Rate for Payer: United Healthcare All Other HMO |
$892.50
|
| Rate for Payer: United Healthcare HMO Rider |
$892.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$892.50
|
| 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 WRIST FX, W/MANIPULAT
|
Facility
|
IP
|
$1,785.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$428.40 |
| Max. Negotiated Rate |
$1,517.25 |
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.00
|
| Rate for Payer: Galaxy Health WC |
$1,517.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,190.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| Rate for Payer: Multiplan Commercial |
$1,428.00
|
| Rate for Payer: Networks By Design Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,517.25
|
|
|
HC CL TRT FEM FX W/O MANIP PE NCK
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
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 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 TRT FEM FX W/O MANIP PE NCK
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
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 TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.56 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.60
|
| Rate for Payer: Galaxy Health WC |
$844.90
|
| Rate for Payer: Global Benefits Group Commercial |
$596.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.56
|
| Rate for Payer: Multiplan Commercial |
$795.20
|
| Rate for Payer: Networks By Design Commercial |
$646.10
|
| Rate for Payer: Prime Health Services Commercial |
$844.90
|
|
|
HC CL TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.21 |
| 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 |
$596.40
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cigna of CA PPO |
$735.56
|
| 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 |
$844.90
|
| Rate for Payer: Global Benefits Group Commercial |
$596.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$745.50
|
| 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 |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.56
|
| 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 |
$795.20
|
| Rate for Payer: Networks By Design Commercial |
$646.10
|
| Rate for Payer: Prime Health Services Commercial |
$844.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$596.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.00
|
| Rate for Payer: United Healthcare All Other HMO |
$497.00
|
| Rate for Payer: United Healthcare HMO Rider |
$497.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.00
|
| 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 TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$2,923.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.27 |
| 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 |
$1,753.80
|
| Rate for Payer: Cash Price |
$1,315.35
|
| Rate for Payer: Cash Price |
$1,315.35
|
| Rate for Payer: Cash Price |
$1,315.35
|
| Rate for Payer: Cigna of CA PPO |
$2,163.02
|
| 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 |
$2,484.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,753.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,192.25
|
| 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 |
$1,949.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.52
|
| 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 |
$2,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,899.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,484.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,753.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,461.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,461.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,461.50
|
| 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 TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$2,923.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$701.52 |
| Max. Negotiated Rate |
$2,484.55 |
| Rate for Payer: Cash Price |
$1,315.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,169.20
|
| Rate for Payer: Galaxy Health WC |
$2,484.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,753.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,949.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,113.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.52
|
| Rate for Payer: Multiplan Commercial |
$2,338.40
|
| Rate for Payer: Networks By Design Commercial |
$1,899.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,484.55
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
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 |
$1,156.20
|
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: Cigna of CA PPO |
$1,425.98
|
| 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 |
$1,637.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,156.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,445.25
|
| 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 |
$1,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.48
|
| 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 |
$1,541.60
|
| Rate for Payer: Networks By Design Commercial |
$1,252.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,156.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$963.50
|
| 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 TRT OF KNEE DISC W/O ANESTH
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.48 |
| Max. Negotiated Rate |
$1,637.95 |
| Rate for Payer: Blue Shield of California Commercial |
$1,372.02
|
| Rate for Payer: Blue Shield of California EPN |
$986.62
|
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.80
|
| Rate for Payer: Galaxy Health WC |
$1,637.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,156.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.48
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Networks By Design Commercial |
$1,252.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.95
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
IP
|
$8,334.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,000.16 |
| Max. Negotiated Rate |
$7,083.90 |
| Rate for Payer: Cash Price |
$3,750.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,333.60
|
| Rate for Payer: Galaxy Health WC |
$7,083.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,000.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,558.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,175.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.16
|
| Rate for Payer: Multiplan Commercial |
$6,667.20
|
| Rate for Payer: Networks By Design Commercial |
$5,417.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,083.90
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
OP
|
$3,956.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$3,362.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.98
|
| Rate for Payer: Blue Distinction Transplant |
$2,373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,338.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,855.36
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna of CA HMO |
$2,531.84
|
| Rate for Payer: Cigna of CA PPO |
$2,927.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$3,362.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,373.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,967.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$3,164.80
|
| Rate for Payer: Networks By Design Commercial |
$2,571.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,362.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,373.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,373.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
