|
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
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
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
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Adventist Health Commercial |
$16.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$55.53
|
| Rate for Payer: Blue Shield of California EPN |
$36.69
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cigna of CA HMO |
$53.12
|
| Rate for Payer: Cigna of CA PPO |
$61.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$70.55
|
| Rate for Payer: Global Benefits Group Commercial |
$49.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Networks By Design Commercial |
$53.95
|
| Rate for Payer: Prime Health Services Commercial |
$70.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$586.15
|
| Rate for Payer: Blue Shield of California Commercial |
$746.86
|
| Rate for Payer: Blue Shield of California EPN |
$491.83
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| 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 |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| 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 |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| 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 |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| 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 |
$1,966.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,229.00
|
| 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 CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,521.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| 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 |
$355.05
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Cigna of CA HMO |
$504.96
|
| Rate for Payer: Cigna of CA PPO |
$583.86
|
| 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 |
$670.65
|
| Rate for Payer: Global Benefits Group Commercial |
$473.40
|
| 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 |
$526.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.36
|
| 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 |
$631.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$512.85
|
| Rate for Payer: Prime Health Services Commercial |
$670.65
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$473.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.50
|
| Rate for Payer: United Healthcare All Other HMO |
$394.50
|
| Rate for Payer: United Healthcare HMO Rider |
$394.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.50
|
| 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 CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$670.65 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| Rate for Payer: Blue Shield of California Commercial |
$582.28
|
| Rate for Payer: Blue Shield of California EPN |
$383.45
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.60
|
| Rate for Payer: EPIC Health Plan Senior |
$315.60
|
| Rate for Payer: Galaxy Health WC |
$670.65
|
| Rate for Payer: Global Benefits Group Commercial |
$473.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$526.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$488.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.36
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: Networks By Design Commercial |
$512.85
|
| Rate for Payer: Prime Health Services Commercial |
$670.65
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$2,077.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.40 |
| Max. Negotiated Rate |
$1,765.45 |
| Rate for Payer: Adventist Health Commercial |
$415.40
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.80
|
| Rate for Payer: EPIC Health Plan Senior |
$830.80
|
| Rate for Payer: Galaxy Health WC |
$1,765.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,385.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$791.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,285.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.48
|
| Rate for Payer: Multiplan Commercial |
$1,661.60
|
| Rate for Payer: Networks By Design Commercial |
$1,350.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,765.45
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$2,077.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$415.40
|
| 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 |
$934.65
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cigna of CA HMO |
$1,329.28
|
| Rate for Payer: Cigna of CA PPO |
$1,536.98
|
| 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 |
$1,765.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.20
|
| 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 |
$1,385.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.48
|
| 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 |
$1,661.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,350.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,765.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,038.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,038.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,038.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,038.50
|
| 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 CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$318.20
|
| 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 |
$715.95
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cigna of CA HMO |
$1,018.24
|
| Rate for Payer: Cigna of CA PPO |
$1,177.34
|
| 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 |
$1,352.35
|
| Rate for Payer: Global Benefits Group Commercial |
$954.60
|
| 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 |
$1,061.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.84
|
| 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 |
$1,272.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,034.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,352.35
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$954.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.50
|
| Rate for Payer: United Healthcare All Other HMO |
$795.50
|
| Rate for Payer: United Healthcare HMO Rider |
$795.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$795.50
|
| 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 CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.20 |
| Max. Negotiated Rate |
$1,352.35 |
| Rate for Payer: Adventist Health Commercial |
$318.20
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$636.40
|
| Rate for Payer: Galaxy Health WC |
$1,352.35
|
| Rate for Payer: Global Benefits Group Commercial |
$954.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,061.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$606.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$984.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.84
|
| Rate for Payer: Multiplan Commercial |
$1,272.80
|
| Rate for Payer: Networks By Design Commercial |
$1,034.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,352.35
|
|
|
HC CL TREAT ANKLE DISCLOC W/ANES
|
Facility
|
OP
|
$4,616.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.58 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$923.20
|
| 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 |
$2,077.20
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: Cigna of CA HMO |
$2,954.24
|
| Rate for Payer: Cigna of CA PPO |
$3,415.84
|
| 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 |
$3,923.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,769.60
|
| 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 |
$3,078.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.84
|
| 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 |
$3,692.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,000.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,923.60
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,769.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,308.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,308.00
|
| 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 CL TREAT ANKLE DISCLOC W/ANES
|
Facility
|
IP
|
$4,616.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.20 |
| Max. Negotiated Rate |
$3,923.60 |
| Rate for Payer: Adventist Health Commercial |
$923.20
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,846.40
|
| Rate for Payer: Galaxy Health WC |
$3,923.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,769.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,078.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,758.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,857.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.84
|
| Rate for Payer: Multiplan Commercial |
$3,692.80
|
| Rate for Payer: Networks By Design Commercial |
$3,000.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,923.60
|
|
|
HC CL TREAT ANKLE MM FX W/O MANIP
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
900501371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| 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 |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| 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 |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| 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 |
$1,048.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| 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 |
$1,257.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$943.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other HMO |
$786.00
|
| Rate for Payer: United Healthcare HMO Rider |
$786.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
| 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 CL TREAT ANKLE MM FX W/O MANIP
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
900501371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.14
|
| Rate for Payer: Blue Shield of California EPN |
$763.99
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$628.80
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,048.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$598.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$973.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC CL TREAT ARTICULAR FX,EA W/MAN
|
Facility
|
IP
|
$4,153.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
900501595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$830.60 |
| Max. Negotiated Rate |
$3,530.05 |
| Rate for Payer: Adventist Health Commercial |
$830.60
|
| Rate for Payer: Cash Price |
$1,868.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,661.20
|
| Rate for Payer: Galaxy Health WC |
$3,530.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,491.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,770.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,570.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.72
|
| Rate for Payer: Multiplan Commercial |
$3,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,699.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,530.05
|
|
|
HC CL TREAT ARTICULAR FX,EA W/MAN
|
Facility
|
OP
|
$4,153.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
900501595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.86 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$830.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$1,868.85
|
| Rate for Payer: Cash Price |
$1,868.85
|
| Rate for Payer: Cash Price |
$1,868.85
|
| Rate for Payer: Cigna of CA HMO |
$2,657.92
|
| Rate for Payer: Cigna of CA PPO |
$3,073.22
|
| 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 |
$3,530.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,491.80
|
| 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 |
$2,770.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.72
|
| 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 |
$3,322.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,699.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,530.05
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,491.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,076.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,076.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,076.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,076.50
|
| 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 CL TREAT ARTICULAR FX,EA W/O M
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
900501557
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
|
|
HC CL TREAT ARTICULAR FX,EA W/O M
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
900501557
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| 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 |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$921.60
|
| Rate for Payer: Cigna of CA PPO |
$1,065.60
|
| 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 |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| 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 |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| 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 |
$1,152.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Other HMO |
$720.00
|
| Rate for Payer: United Healthcare HMO Rider |
$720.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.00
|
| 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 CL TREAT BIMALL ANKLE FX W/MAN
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
900501093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,878.50 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Senior |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,367.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
|
|
HC CL TREAT BIMALL ANKLE FX W/MAN
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
900501093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$442.00
|
| 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 |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cigna of CA HMO |
$1,414.40
|
| Rate for Payer: Cigna of CA PPO |
$1,635.40
|
| 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 |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| 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 |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$530.40
|
| 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 |
$1,768.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,436.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,105.00
|
| 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 CL TREAT BIMALL ANKLE FX W/O M
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
900501519
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| 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 |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cigna of CA HMO |
$968.32
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| 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 |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| 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 |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| 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 |
$1,210.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other HMO |
$756.50
|
| Rate for Payer: United Healthcare HMO Rider |
$756.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.50
|
| 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 CL TREAT BIMALL ANKLE FX W/O M
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 27808
|
| Hospital Charge Code |
900501519
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,286.05 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$936.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
