|
HC CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
|
IP
|
$5,936.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,187.20 |
| Max. Negotiated Rate |
$5,045.60 |
| Rate for Payer: Adventist Health Commercial |
$1,187.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,374.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,374.40
|
| Rate for Payer: Galaxy Health WC |
$5,045.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,561.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,261.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,674.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.64
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: Networks By Design Commercial |
$3,858.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,045.60
|
|
|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
|
OP
|
$5,174.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.89 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,034.80
|
| 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 |
$2,328.30
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Cigna of CA HMO |
$3,311.36
|
| Rate for Payer: Cigna of CA PPO |
$3,828.76
|
| 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 |
$4,397.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,104.40
|
| 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 |
$3,451.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.76
|
| 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 |
$4,139.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,363.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,104.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,587.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,587.00
|
| 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 MED MALL FX W/MANIPUL
|
Facility
|
IP
|
$5,174.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,034.80 |
| Max. Negotiated Rate |
$4,397.90 |
| Rate for Payer: Adventist Health Commercial |
$1,034.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,818.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,514.56
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,069.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,069.60
|
| Rate for Payer: Galaxy Health WC |
$4,397.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,451.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,971.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,202.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.76
|
| Rate for Payer: Multiplan Commercial |
$4,139.20
|
| Rate for Payer: Networks By Design Commercial |
$3,363.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.90
|
|
|
HC CL TREAT METACARPAL FX, SNGL
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
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: 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 METACARPAL FX, SNGL
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
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 |
$3,171.00
|
| 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 METACARPAL W/MANIPULA
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Adventist Health Commercial |
$331.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$662.40
|
| Rate for Payer: Galaxy Health WC |
$1,407.60
|
| Rate for Payer: Global Benefits Group Commercial |
$993.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,104.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$630.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,025.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.44
|
| Rate for Payer: Multiplan Commercial |
$1,324.80
|
| Rate for Payer: Networks By Design Commercial |
$1,076.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.60
|
|
|
HC CL TREAT METACARPAL W/MANIPULA
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.56 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$331.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna of CA HMO |
$1,059.84
|
| Rate for Payer: Cigna of CA PPO |
$1,225.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,407.60
|
| Rate for Payer: Global Benefits Group Commercial |
$993.60
|
| 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 |
$1,104.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,324.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,076.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$828.00
|
| Rate for Payer: United Healthcare All Other HMO |
$828.00
|
| Rate for Payer: United Healthcare HMO Rider |
$828.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.00
|
| 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 META FX SNGL W/MAN
|
Facility
|
IP
|
$2,119.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$1,801.15 |
| Rate for Payer: Adventist Health Commercial |
$423.80
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$847.60
|
| Rate for Payer: EPIC Health Plan Senior |
$847.60
|
| Rate for Payer: Galaxy Health WC |
$1,801.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,271.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,413.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$807.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,311.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$1,695.20
|
| Rate for Payer: Networks By Design Commercial |
$1,377.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,801.15
|
|
|
HC CL TREAT META FX SNGL W/MAN
|
Facility
|
OP
|
$2,119.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$423.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$953.55
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Cigna of CA HMO |
$1,356.16
|
| Rate for Payer: Cigna of CA PPO |
$1,568.06
|
| 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 |
$1,801.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,271.40
|
| 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 |
$1,413.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.56
|
| 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 |
$1,695.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,377.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,801.15
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,271.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,059.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,059.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,059.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,059.50
|
| 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 META FX W/EXT FIX EA
|
Facility
|
OP
|
$6,174.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$772.45 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,234.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$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 |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$5,247.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,704.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$772.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$4,939.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| 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 |
$6,501.60
|
| 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 |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC CL TREAT META FX W/EXT FIX EA
|
Facility
|
IP
|
$6,174.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
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 MOUTH ROOF FX
|
Facility
|
IP
|
$4,717.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.40 |
| Max. Negotiated Rate |
$4,009.45 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,886.80
|
| Rate for Payer: Galaxy Health WC |
$4,009.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,830.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,146.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,797.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,132.08
|
| Rate for Payer: Multiplan Commercial |
$3,773.60
|
| Rate for Payer: Networks By Design Commercial |
$3,066.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,009.45
|
|
|
HC CL TREAT MOUTH ROOF FX
|
Facility
|
OP
|
$4,717.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.94 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| 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 |
$8,712.00
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cigna of CA HMO |
$3,018.88
|
| Rate for Payer: Cigna of CA PPO |
$3,490.58
|
| 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 |
$4,009.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,830.20
|
| 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 |
$3,146.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,132.08
|
| 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 |
$3,773.60
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,066.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,009.45
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,830.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,358.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,358.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,358.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,358.50
|
| 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
|
|
|
HC CL TREAT NASAL SEPTAL FX
|
Facility
|
OP
|
$6,548.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cigna of CA HMO |
$4,190.72
|
| Rate for Payer: Cigna of CA PPO |
$4,845.52
|
| 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 |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| 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 |
$4,367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| 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 |
$5,238.40
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,928.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,274.00
|
| 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
|
|
|
HC CL TREAT NASAL SEPTAL FX
|
Facility
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,309.60 |
| Max. Negotiated Rate |
$5,565.80 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,619.20
|
| Rate for Payer: Galaxy Health WC |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,494.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,053.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Multiplan Commercial |
$5,238.40
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
|
|
HC CL TREAT OF ACROMICLAV W/MANIP
|
Facility
|
OP
|
$4,774.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| 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 |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cigna of CA HMO |
$3,055.36
|
| Rate for Payer: Cigna of CA PPO |
$3,532.76
|
| 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 |
$4,057.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,864.40
|
| 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 |
$3,184.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.76
|
| 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 |
$3,819.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$3,103.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,057.90
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,864.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,387.00
|
| 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 OF ACROMICLAV W/MANIP
|
Facility
|
IP
|
$4,774.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$954.80 |
| Max. Negotiated Rate |
$4,057.90 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,909.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,909.60
|
| Rate for Payer: Galaxy Health WC |
$4,057.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,864.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,184.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,818.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,955.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.76
|
| Rate for Payer: Multiplan Commercial |
$3,819.20
|
| Rate for Payer: Networks By Design Commercial |
$3,103.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,057.90
|
|
|
HC CL TREAT OF CARPOMETACARPAL
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.00 |
| 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 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 OF CARPOMETACARPAL
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
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 OF CLAV FRAC W/MANIPU
|
Facility
|
IP
|
$6,497.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,299.40 |
| Max. Negotiated Rate |
$5,522.45 |
| Rate for Payer: Adventist Health Commercial |
$1,299.40
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,598.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,598.80
|
| Rate for Payer: Galaxy Health WC |
$5,522.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,475.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,021.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.28
|
| Rate for Payer: Multiplan Commercial |
$5,197.60
|
| Rate for Payer: Networks By Design Commercial |
$4,223.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,522.45
|
|
|
HC CL TREAT OF CLAV FRAC W/MANIPU
|
Facility
|
OP
|
$6,497.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.19 |
| Max. Negotiated Rate |
$5,522.45 |
| Rate for Payer: Adventist Health Commercial |
$1,299.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Cigna of CA HMO |
$4,158.08
|
| Rate for Payer: Cigna of CA PPO |
$4,807.78
|
| 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 |
$5,522.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,333.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.28
|
| 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 |
$5,197.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,223.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,522.45
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,898.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,248.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,248.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,248.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,248.50
|
| 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 OF CLAV FRAC W/O MANI
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| 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 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 OF CLAV FRAC W/O MANI
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
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
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
|
IP
|
$3,669.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$3,118.65 |
| Rate for Payer: Adventist Health Commercial |
$733.80
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,467.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,467.60
|
| Rate for Payer: Galaxy Health WC |
$3,118.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,201.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,447.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,397.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,271.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.56
|
| Rate for Payer: Multiplan Commercial |
$2,935.20
|
| Rate for Payer: Networks By Design Commercial |
$2,384.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,118.65
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
|
OP
|
$3,669.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$515.68 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$733.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$1,651.05
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cigna of CA HMO |
$2,348.16
|
| Rate for Payer: Cigna of CA PPO |
$2,715.06
|
| 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 |
$3,118.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,201.40
|
| 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 |
$2,447.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.56
|
| 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 |
$2,935.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,384.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,118.65
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,201.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,834.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.50
|
| 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
|
|
