|
HC CL TREAT HIP DISC TR W/ANESTH
|
Facility
|
IP
|
$3,813.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
900501083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$762.60 |
| Max. Negotiated Rate |
$3,241.05 |
| Rate for Payer: Adventist Health Commercial |
$762.60
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,525.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,525.20
|
| Rate for Payer: Galaxy Health WC |
$3,241.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,287.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,543.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,452.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,360.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.12
|
| Rate for Payer: Multiplan Commercial |
$3,050.40
|
| Rate for Payer: Networks By Design Commercial |
$2,478.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,241.05
|
|
|
HC CL TREAT HIP DISC TR W/ANESTH
|
Facility
|
OP
|
$3,813.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
900501083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$762.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$762.60
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: Cigna of CA HMO |
$2,440.32
|
| Rate for Payer: Cigna of CA PPO |
$2,821.62
|
| 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 |
$3,241.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,287.80
|
| 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 |
$2,543.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.12
|
| 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 |
$3,050.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,478.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,241.05
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,287.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,906.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,906.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,906.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,906.50
|
| 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 HIP DISC TR W/O ANEST
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
900501228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.00 |
| Max. Negotiated Rate |
$1,381.25 |
| Rate for Payer: Adventist Health Commercial |
$325.00
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.00
|
| Rate for Payer: EPIC Health Plan Senior |
$650.00
|
| Rate for Payer: Galaxy Health WC |
$1,381.25
|
| Rate for Payer: Global Benefits Group Commercial |
$975.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,005.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.00
|
| Rate for Payer: Multiplan Commercial |
$1,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,056.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,381.25
|
|
|
HC CL TREAT HIP DISC TR W/O ANEST
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
900501228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$325.00
|
| 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 |
$731.25
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Cigna of CA HMO |
$1,040.00
|
| Rate for Payer: Cigna of CA PPO |
$1,202.50
|
| 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 |
$1,381.25
|
| Rate for Payer: Global Benefits Group Commercial |
$975.00
|
| 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 |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.00
|
| 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 |
$1,300.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,056.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,381.25
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$812.50
|
| Rate for Payer: United Healthcare HMO Rider |
$812.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$812.50
|
| 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 HUMERAL FRAC W/O MANI
|
Facility
|
OP
|
$1,660.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
900501326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| 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 |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna of CA HMO |
$1,062.40
|
| Rate for Payer: Cigna of CA PPO |
$1,228.40
|
| 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 |
$1,411.00
|
| Rate for Payer: Global Benefits Group Commercial |
$996.00
|
| 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 |
$1,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.40
|
| 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 |
$1,328.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,079.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,411.00
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$996.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$830.00
|
| Rate for Payer: United Healthcare All Other HMO |
$830.00
|
| Rate for Payer: United Healthcare HMO Rider |
$830.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$830.00
|
| 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 HUMERAL FRAC W/O MANI
|
Facility
|
IP
|
$1,660.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
900501326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.00 |
| Max. Negotiated Rate |
$1,411.00 |
| Rate for Payer: Adventist Health Commercial |
$332.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$664.00
|
| Rate for Payer: EPIC Health Plan Senior |
$664.00
|
| Rate for Payer: Galaxy Health WC |
$1,411.00
|
| Rate for Payer: Global Benefits Group Commercial |
$996.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,107.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$632.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,027.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.40
|
| Rate for Payer: Multiplan Commercial |
$1,328.00
|
| Rate for Payer: Networks By Design Commercial |
$1,079.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,411.00
|
|
|
HC CL TREAT HUMERAL FX W/MANIPULA
|
Facility
|
IP
|
$2,583.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
900501497
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$2,195.55 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,033.20
|
| Rate for Payer: Galaxy Health WC |
$2,195.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,722.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,598.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.92
|
| Rate for Payer: Multiplan Commercial |
$2,066.40
|
| Rate for Payer: Networks By Design Commercial |
$1,678.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,195.55
|
|
|
HC CL TREAT HUMERAL FX W/MANIPULA
|
Facility
|
OP
|
$2,583.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
900501497
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$493.75 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| 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 |
$1,162.35
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: Cigna of CA HMO |
$1,653.12
|
| Rate for Payer: Cigna of CA PPO |
$1,911.42
|
| 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 |
$2,195.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.80
|
| 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 |
$1,722.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.92
|
| 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 |
$2,066.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,678.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,195.55
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,549.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,291.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,291.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,291.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,291.50
|
| 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 HUMERAL SHAFT FX W/O
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
900501520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$1,161.95 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$546.80
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$846.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
|
|
HC CL TREAT HUMERAL SHAFT FX W/O
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
900501520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| 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 |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cigna of CA HMO |
$874.88
|
| Rate for Payer: Cigna of CA PPO |
$1,011.58
|
| 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 |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| 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 |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| 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 |
$1,093.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$820.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.50
|
| Rate for Payer: United Healthcare All Other HMO |
$683.50
|
| Rate for Payer: United Healthcare HMO Rider |
$683.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.50
|
| 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 HUMERUS FX W/MANIPULA
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
900501365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$511.42 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| 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 |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cigna of CA HMO |
$1,900.80
|
| Rate for Payer: Cigna of CA PPO |
$2,197.80
|
| 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 |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| 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 |
$1,980.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$511.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| 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 |
$2,376.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,485.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,485.00
|
| 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 HUMERUS FX W/MANIPULA
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
900501365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,188.00
|
| Rate for Payer: Galaxy Health WC |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,980.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,131.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,838.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| Rate for Payer: Multiplan Commercial |
$2,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
|
|
HC CL TREAT HUMERUS FX W/O MANIPU
|
Facility
|
OP
|
$1,268.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
900501566
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$115.29 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$253.60
|
| 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 |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: Cigna of CA HMO |
$811.52
|
| Rate for Payer: Cigna of CA PPO |
$938.32
|
| 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 |
$1,077.80
|
| Rate for Payer: Global Benefits Group Commercial |
$760.80
|
| 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 |
$845.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.32
|
| 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 |
$1,014.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$824.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,077.80
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$760.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$634.00
|
| Rate for Payer: United Healthcare HMO Rider |
$634.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$634.00
|
| 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 HUMERUS FX W/O MANIPU
|
Facility
|
IP
|
$1,268.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
900501566
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.60 |
| Max. Negotiated Rate |
$1,077.80 |
| Rate for Payer: Adventist Health Commercial |
$253.60
|
| Rate for Payer: Cash Price |
$570.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$507.20
|
| Rate for Payer: EPIC Health Plan Senior |
$507.20
|
| Rate for Payer: Galaxy Health WC |
$1,077.80
|
| Rate for Payer: Global Benefits Group Commercial |
$760.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$845.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$483.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.32
|
| Rate for Payer: Multiplan Commercial |
$1,014.40
|
| Rate for Payer: Networks By Design Commercial |
$824.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,077.80
|
|
|
HC CL TREAT INTPHAL JOINT SIN W/A
|
Facility
|
OP
|
$5,283.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
900501080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$337.45 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,056.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,377.35
|
| Rate for Payer: Cash Price |
$2,377.35
|
| Rate for Payer: Cash Price |
$2,377.35
|
| Rate for Payer: Cigna of CA HMO |
$3,381.12
|
| Rate for Payer: Cigna of CA PPO |
$3,909.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$4,490.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,169.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,523.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$4,226.40
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$3,433.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,490.55
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,169.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,641.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,641.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,641.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,641.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC CL TREAT INTPHAL JOINT SIN W/A
|
Facility
|
IP
|
$5,283.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
900501080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,056.60 |
| Max. Negotiated Rate |
$4,490.55 |
| Rate for Payer: Adventist Health Commercial |
$1,056.60
|
| Rate for Payer: Cash Price |
$2,377.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,113.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,113.20
|
| Rate for Payer: Galaxy Health WC |
$4,490.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,169.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,523.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,012.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,270.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,267.92
|
| Rate for Payer: Multiplan Commercial |
$4,226.40
|
| Rate for Payer: Networks By Design Commercial |
$3,433.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,490.55
|
|
|
HC CL TREAT KNEE FRACTURES
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
900501533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.60 |
| 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 |
$172.60
|
| 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 KNEE FRACTURES
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
900501533
|
|
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: Blue Shield of California Commercial |
$1,062.72
|
| Rate for Payer: Blue Shield of California EPN |
$699.84
|
| 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 LUNATE DISLOCA W/MANI
|
Facility
|
OP
|
$6,174.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
900501383
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.69 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,234.80
|
| 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 |
$2,778.30
|
| Rate for Payer: Cash Price |
$2,778.30
|
| Rate for Payer: Cash Price |
$2,778.30
|
| Rate for Payer: Cigna of CA HMO |
$3,951.36
|
| Rate for Payer: Cigna of CA PPO |
$4,568.76
|
| 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 |
$5,247.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,704.40
|
| 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 |
$4,118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.76
|
| 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 |
$4,939.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,013.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,247.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,704.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,087.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,087.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,087.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,087.00
|
| 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 LUNATE DISLOCA W/MANI
|
Facility
|
IP
|
$6,174.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
900501383
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,234.80 |
| Max. Negotiated Rate |
$5,247.90 |
| Rate for Payer: Adventist Health Commercial |
$1,234.80
|
| Rate for Payer: Cash Price |
$2,778.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,469.60
|
| Rate for Payer: Galaxy Health WC |
$5,247.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,704.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,352.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,821.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.76
|
| Rate for Payer: Multiplan Commercial |
$4,939.20
|
| Rate for Payer: Networks By Design Commercial |
$4,013.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,247.90
|
|
|
HC CL TREAT MANDIBULAR FX
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
900501369
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,075.60 |
| Max. Negotiated Rate |
$13,071.30 |
| Rate for Payer: Adventist Health Commercial |
$3,075.60
|
| Rate for Payer: Cash Price |
$6,920.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,151.20
|
| Rate for Payer: Galaxy Health WC |
$13,071.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,226.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,257.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,859.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,518.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,690.72
|
| Rate for Payer: Multiplan Commercial |
$12,302.40
|
| Rate for Payer: Networks By Design Commercial |
$9,995.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,071.30
|
|
|
HC CL TREAT MANDIBULAR FX
|
Facility
|
OP
|
$15,378.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
900501369
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$13,071.30 |
| Rate for Payer: Adventist Health Commercial |
$3,075.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$6,920.10
|
| Rate for Payer: Cash Price |
$6,920.10
|
| Rate for Payer: Cash Price |
$6,920.10
|
| Rate for Payer: Cigna of CA HMO |
$9,841.92
|
| Rate for Payer: Cigna of CA PPO |
$11,379.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$13,071.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,226.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,257.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,690.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,470.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$12,302.40
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$9,995.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,071.30
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,689.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,689.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,689.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,689.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
|
IP
|
$13,308.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,661.60 |
| Max. Negotiated Rate |
$11,311.80 |
| Rate for Payer: Adventist Health Commercial |
$2,661.60
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,323.20
|
| Rate for Payer: Galaxy Health WC |
$11,311.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,984.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,876.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,070.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,237.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.92
|
| Rate for Payer: Multiplan Commercial |
$10,646.40
|
| Rate for Payer: Networks By Design Commercial |
$8,650.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,311.80
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
|
OP
|
$13,308.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$720.10 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$2,661.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$8,712.00
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: Cigna of CA HMO |
$8,517.12
|
| Rate for Payer: Cigna of CA PPO |
$9,847.92
|
| 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 |
$11,311.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,984.80
|
| 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 |
$8,876.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.92
|
| 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 |
$10,646.40
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$8,650.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,311.80
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,984.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,654.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,654.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,654.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,654.00
|
| 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 CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
|
OP
|
$5,936.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.53 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,187.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cigna of CA HMO |
$3,799.04
|
| Rate for Payer: Cigna of CA PPO |
$4,392.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$5,045.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,561.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,858.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,045.60
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,561.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,968.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,968.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,968.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
