|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
IP
|
$6,087.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,460.88 |
| Max. Negotiated Rate |
$5,173.95 |
| Rate for Payer: Blue Shield of California Commercial |
$4,333.94
|
| Rate for Payer: Blue Shield of California EPN |
$3,116.54
|
| Rate for Payer: Cash Price |
$2,739.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,434.80
|
| Rate for Payer: Galaxy Health WC |
$5,173.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,652.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,060.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,319.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,460.88
|
| Rate for Payer: Multiplan Commercial |
$4,869.60
|
| Rate for Payer: Networks By Design Commercial |
$3,956.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,173.95
|
|
|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
OP
|
$6,087.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.90 |
| Max. Negotiated Rate |
$5,173.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$3,652.20
|
| Rate for Payer: Cash Price |
$2,739.15
|
| Rate for Payer: Cash Price |
$2,739.15
|
| Rate for Payer: Cash Price |
$2,739.15
|
| Rate for Payer: Cigna of CA PPO |
$4,504.38
|
| 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 |
$5,173.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,652.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,565.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,060.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,460.88
|
| 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 |
$4,869.60
|
| Rate for Payer: Networks By Design Commercial |
$3,956.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,173.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,652.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,652.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,043.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,043.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,043.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,043.50
|
| 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 METACARPAL FX, SNGL
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
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 METACARPAL FX, SNGL
|
Facility
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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: Redlands Yucaipa Medical Group Commercial/Senior |
$964.80
|
| 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 METACARPAL W/MANIPULA
|
Facility
OP
|
$1,694.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.56 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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 |
$264.56
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,016.40
|
| 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 METACARPAL W/MANIPULA
|
Facility
IP
|
$1,694.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$406.56 |
| Max. Negotiated Rate |
$1,439.90 |
| 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 META FX SNGL W/MAN
|
Facility
OP
|
$2,493.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,495.80
|
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: Cigna of CA PPO |
$1,844.82
|
| 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 |
$2,119.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,495.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,869.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,662.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.32
|
| 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 |
$1,994.40
|
| Rate for Payer: Networks By Design Commercial |
$1,620.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,119.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,495.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,495.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,246.50
|
| 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 META FX SNGL W/MAN
|
Facility
IP
|
$2,493.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$598.32 |
| Max. Negotiated Rate |
$2,119.05 |
| Rate for Payer: Cash Price |
$1,121.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$997.20
|
| Rate for Payer: Galaxy Health WC |
$2,119.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,495.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,662.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$949.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$598.32
|
| Rate for Payer: Multiplan Commercial |
$1,994.40
|
| Rate for Payer: Networks By Design Commercial |
$1,620.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,119.05
|
|
|
HC CL TREAT META FX W/EXT FIX EA
|
Facility
OP
|
$6,316.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$772.44 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant 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 |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,368.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,789.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,737.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,212.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$772.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,515.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$3,789.60
|
| 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 |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC CL TREAT META FX W/EXT FIX EA
|
Facility
IP
|
$6,316.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
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 MOUTH ROOF FX
|
Facility
IP
|
$5,842.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,402.08 |
| Max. Negotiated Rate |
$4,965.70 |
| Rate for Payer: Cash Price |
$2,628.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,336.80
|
| Rate for Payer: Galaxy Health WC |
$4,965.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,505.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,896.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,225.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,402.08
|
| Rate for Payer: Multiplan Commercial |
$4,673.60
|
| Rate for Payer: Networks By Design Commercial |
$3,797.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,965.70
|
|
|
HC CL TREAT MOUTH ROOF FX
|
Facility
OP
|
$5,842.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.94 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,505.20
|
| Rate for Payer: Cash Price |
$2,628.90
|
| Rate for Payer: Cash Price |
$2,628.90
|
| Rate for Payer: Cash Price |
$2,628.90
|
| Rate for Payer: Cigna of CA PPO |
$4,323.08
|
| 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 |
$4,965.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,505.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,381.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,896.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,402.08
|
| 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 |
$4,673.60
|
| Rate for Payer: Networks By Design Commercial |
$3,797.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,965.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,505.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,505.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,921.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,921.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,921.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,921.00
|
| 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 NASAL SEPTAL FX
|
Facility
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,848.96 |
| Max. Negotiated Rate |
$6,548.40 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC CL TREAT NASAL SEPTAL FX
|
Facility
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,622.40
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| 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 |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| 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 |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,622.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| 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 OF ACROMICLAV W/MANIP
|
Facility
OP
|
$4,885.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.40 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,931.00
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: Cigna of CA PPO |
$3,614.90
|
| 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 |
$4,152.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,663.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.40
|
| 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 |
$3,908.00
|
| Rate for Payer: Networks By Design Commercial |
$3,175.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,152.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,931.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,931.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,442.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,442.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,442.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,442.50
|
| 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 OF ACROMICLAV W/MANIP
|
Facility
IP
|
$4,885.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,172.40 |
| Max. Negotiated Rate |
$4,152.25 |
| Rate for Payer: Cash Price |
$2,198.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.00
|
| Rate for Payer: Galaxy Health WC |
$4,152.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,861.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.40
|
| Rate for Payer: Multiplan Commercial |
$3,908.00
|
| Rate for Payer: Networks By Design Commercial |
$3,175.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,152.25
|
|
|
HC CL TREAT OF CARPOMETACARPAL
|
Facility
IP
|
$3,039.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
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 OF CARPOMETACARPAL
|
Facility
OP
|
$3,039.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,823.40
|
| 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 Senior |
$2,008.09
|
|
|
HC CL TREAT OF CLAV FRAC W/MANIPU
|
Facility
IP
|
$6,647.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,595.28 |
| Max. Negotiated Rate |
$5,649.95 |
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,658.80
|
| Rate for Payer: Galaxy Health WC |
$5,649.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,532.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,595.28
|
| Rate for Payer: Multiplan Commercial |
$5,317.60
|
| Rate for Payer: Networks By Design Commercial |
$4,320.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,649.95
|
|
|
HC CL TREAT OF CLAV FRAC W/MANIPU
|
Facility
OP
|
$6,647.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.18 |
| Max. Negotiated Rate |
$5,649.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$3,988.20
|
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: Cigna of CA PPO |
$4,918.78
|
| 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 |
$5,649.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,988.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,985.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,595.28
|
| 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 |
$5,317.60
|
| Rate for Payer: Networks By Design Commercial |
$4,320.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,649.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,988.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,988.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,323.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,323.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,323.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,323.50
|
| 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 OF CLAV FRAC W/O MANI
|
Facility
OP
|
$1,780.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,068.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna of CA PPO |
$1,317.20
|
| 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 |
$1,513.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,068.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,335.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,187.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.20
|
| 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 |
$1,424.00
|
| Rate for Payer: Networks By Design Commercial |
$1,157.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,513.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,068.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,068.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$890.00
|
| Rate for Payer: United Healthcare All Other HMO |
$890.00
|
| Rate for Payer: United Healthcare HMO Rider |
$890.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$890.00
|
| 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 OF CLAV FRAC W/O MANI
|
Facility
IP
|
$1,780.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.20 |
| Max. Negotiated Rate |
$1,513.00 |
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.00
|
| Rate for Payer: Galaxy Health WC |
$1,513.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,068.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,187.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.20
|
| Rate for Payer: Multiplan Commercial |
$1,424.00
|
| Rate for Payer: Networks By Design Commercial |
$1,157.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,513.00
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
IP
|
$4,317.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,036.08 |
| Max. Negotiated Rate |
$3,669.45 |
| Rate for Payer: Cash Price |
$1,942.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,726.80
|
| Rate for Payer: Galaxy Health WC |
$3,669.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,590.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,879.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,644.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.08
|
| Rate for Payer: Multiplan Commercial |
$3,453.60
|
| Rate for Payer: Networks By Design Commercial |
$2,806.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,669.45
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
OP
|
$4,317.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$515.68 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,590.20
|
| Rate for Payer: Cash Price |
$1,942.65
|
| Rate for Payer: Cash Price |
$1,942.65
|
| Rate for Payer: Cash Price |
$1,942.65
|
| Rate for Payer: Cigna of CA PPO |
$3,194.58
|
| 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 |
$3,669.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,590.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,237.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,879.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,036.08
|
| 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 |
$3,453.60
|
| Rate for Payer: Networks By Design Commercial |
$2,806.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,669.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,590.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,590.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,158.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,158.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,158.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,158.50
|
| 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 OF DIS RAD FX W/O MAN
|
Facility
IP
|
$2,225.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$534.00 |
| Max. Negotiated Rate |
$1,891.25 |
| Rate for Payer: Cash Price |
$1,001.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.00
|
| Rate for Payer: Galaxy Health WC |
$1,891.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,335.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,484.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$847.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.00
|
| Rate for Payer: Multiplan Commercial |
$1,780.00
|
| Rate for Payer: Networks By Design Commercial |
$1,446.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,891.25
|
|
