|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.88
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$11.33
|
| Rate for Payer: Cigna of CA PPO |
$13.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Networks By Design Commercial |
$11.51
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare HMO Rider |
$8.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Networks By Design Commercial |
$11.51
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
|
|
HC CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
OP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.80
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Cigna of CA HMO |
$14.38
|
| Rate for Payer: Cigna of CA PPO |
$16.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.73
|
| Rate for Payer: Multiplan Commercial |
$17.98
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.23
|
| Rate for Payer: United Healthcare All Other HMO |
$11.23
|
| Rate for Payer: United Healthcare HMO Rider |
$11.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19.10
|
|
|
HC CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
IP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$17.98
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
|
|
HC CLNSR FOAM NO RINSE 4OZ
|
Facility
|
IP
|
$10.74
|
|
| Hospital Charge Code |
901698845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
|
|
HC CLNSR FOAM NO RINSE 4OZ
|
Facility
|
OP
|
$10.74
|
|
| Hospital Charge Code |
901698845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.60
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.52
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Vantage Medical Group Senior |
$9.13
|
|
|
HC CLNSR WOUND ANASEPT SPRAY 8OZ
|
Facility
|
OP
|
$90.97
|
|
| Hospital Charge Code |
901698216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Adventist Health Commercial |
$18.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.86
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cigna of CA HMO |
$58.22
|
| Rate for Payer: Cigna of CA PPO |
$67.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.39
|
| Rate for Payer: EPIC Health Plan Senior |
$36.39
|
| Rate for Payer: Galaxy Health WC |
$77.32
|
| Rate for Payer: Global Benefits Group Commercial |
$54.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.68
|
| Rate for Payer: Multiplan Commercial |
$72.78
|
| Rate for Payer: Networks By Design Commercial |
$59.13
|
| Rate for Payer: Prime Health Services Commercial |
$77.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.48
|
| Rate for Payer: United Healthcare All Other HMO |
$45.48
|
| Rate for Payer: United Healthcare HMO Rider |
$45.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.32
|
| Rate for Payer: Vantage Medical Group Senior |
$77.32
|
|
|
HC CLNSR WOUND ANASEPT SPRAY 8OZ
|
Facility
|
IP
|
$90.97
|
|
| Hospital Charge Code |
901698216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Adventist Health Commercial |
$18.19
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.39
|
| Rate for Payer: EPIC Health Plan Senior |
$36.39
|
| Rate for Payer: Galaxy Health WC |
$77.32
|
| Rate for Payer: Global Benefits Group Commercial |
$54.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.83
|
| Rate for Payer: Multiplan Commercial |
$72.78
|
| Rate for Payer: Networks By Design Commercial |
$59.13
|
| Rate for Payer: Prime Health Services Commercial |
$77.32
|
|
|
HC CLNSR WOUND MICROKLENZ AMB 8OZ
|
Facility
|
OP
|
$28.37
|
|
| Hospital Charge Code |
901605885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.42
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cigna of CA HMO |
$18.16
|
| Rate for Payer: Cigna of CA PPO |
$20.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.86
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.19
|
| Rate for Payer: United Healthcare All Other HMO |
$14.19
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.11
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC CLNSR WOUND MICROKLENZ AMB 8OZ
|
Facility
|
IP
|
$28.37
|
|
| Hospital Charge Code |
901605885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
|
|
HC CLOSE ABBOTT PERCLOSE PROGLIDE
|
Facility
|
OP
|
$1,357.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
906812452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$1,153.45 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$746.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,017.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$785.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.47
|
| Rate for Payer: Blue Shield of California EPN |
$659.50
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,153.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,153.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$949.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$949.90
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$814.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$814.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,153.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,153.45
|
|
|
HC CLOSE ABBOTT PERCLOSE PROGLIDE
|
Facility
|
IP
|
$1,357.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
906812452
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$271.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cash Price |
$610.65
|
| Rate for Payer: Cigna of CA HMO |
$949.90
|
| Rate for Payer: Cigna of CA PPO |
$949.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.80
|
| Rate for Payer: EPIC Health Plan Senior |
$542.80
|
| Rate for Payer: Galaxy Health WC |
$1,153.45
|
| Rate for Payer: Global Benefits Group Commercial |
$814.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$905.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$517.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$839.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$1,085.60
|
| Rate for Payer: Networks By Design Commercial |
$678.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,153.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.28
|
| Rate for Payer: United Healthcare All Other HMO |
$495.71
|
| Rate for Payer: United Healthcare HMO Rider |
$484.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$444.42
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
OP
|
$3,440.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.29 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$688.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna of CA HMO |
$2,201.60
|
| Rate for Payer: Cigna of CA PPO |
$2,545.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$2,924.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,064.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,294.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$2,752.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,236.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,924.00
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,720.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,720.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,720.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,720.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
IP
|
$3,440.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$688.00 |
| Max. Negotiated Rate |
$2,924.00 |
| Rate for Payer: Adventist Health Commercial |
$688.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,376.00
|
| Rate for Payer: Galaxy Health WC |
$2,924.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,064.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,294.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,310.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,129.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.60
|
| Rate for Payer: Multiplan Commercial |
$2,752.00
|
| Rate for Payer: Networks By Design Commercial |
$2,236.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,924.00
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cigna of CA HMO |
$521.60
|
| Rate for Payer: Cigna of CA PPO |
$603.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$692.75
|
| Rate for Payer: Global Benefits Group Commercial |
$489.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$543.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$529.75
|
| Rate for Payer: Prime Health Services Commercial |
$692.75
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$489.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.50
|
| Rate for Payer: United Healthcare All Other HMO |
$407.50
|
| Rate for Payer: United Healthcare HMO Rider |
$407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$692.75 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$326.00
|
| Rate for Payer: Galaxy Health WC |
$692.75
|
| Rate for Payer: Global Benefits Group Commercial |
$489.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$543.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$310.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$504.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.60
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: Networks By Design Commercial |
$529.75
|
| Rate for Payer: Prime Health Services Commercial |
$692.75
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
OP
|
$3,531.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$706.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$706.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cigna of CA HMO |
$2,259.84
|
| Rate for Payer: Cigna of CA PPO |
$2,612.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$3,001.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,118.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,355.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$756.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$2,824.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$2,295.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,001.35
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,118.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,765.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,765.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,765.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,765.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
IP
|
$3,531.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$706.20 |
| Max. Negotiated Rate |
$3,001.35 |
| Rate for Payer: Adventist Health Commercial |
$706.20
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,412.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,412.40
|
| Rate for Payer: Galaxy Health WC |
$3,001.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,118.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,355.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,345.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,185.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.44
|
| Rate for Payer: Multiplan Commercial |
$2,824.80
|
| Rate for Payer: Networks By Design Commercial |
$2,295.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,001.35
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$591.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$637.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$640.40
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$991.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.94 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO |
$1,024.64
|
| Rate for Payer: Cigna of CA PPO |
$1,184.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,067.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$800.50
|
| Rate for Payer: United Healthcare All Other HMO |
$800.50
|
| Rate for Payer: United Healthcare HMO Rider |
$800.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$800.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$445.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cigna of CA HMO |
$1,425.28
|
| Rate for Payer: Cigna of CA PPO |
$1,647.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$1,892.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,485.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.95
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,336.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$445.40 |
| Max. Negotiated Rate |
$1,892.95 |
| Rate for Payer: Adventist Health Commercial |
$445.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,643.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,082.32
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.80
|
| Rate for Payer: EPIC Health Plan Senior |
$890.80
|
| Rate for Payer: Galaxy Health WC |
$1,892.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,485.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,378.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.48
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: Networks By Design Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.95
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
