|
HC CL TREAT OF DIS RAD FX W/O MAN
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$378.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cigna of CA HMO |
$1,210.24
|
| Rate for Payer: Cigna of CA PPO |
$1,399.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| 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 |
$1,261.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$945.50
|
| Rate for Payer: United Healthcare All Other HMO |
$945.50
|
| Rate for Payer: United Healthcare HMO Rider |
$945.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$945.50
|
| 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 DIS RAD FX W/O MAN
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.20 |
| Max. Negotiated Rate |
$1,607.35 |
| Rate for Payer: Adventist Health Commercial |
$378.20
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$756.40
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,261.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,170.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
|
|
HC CL TREAT OF ELB DISLOC W/ANEST
|
Facility
|
OP
|
$5,546.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$328.93 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,109.20
|
| 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 |
$2,495.70
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Cigna of CA HMO |
$3,549.44
|
| Rate for Payer: Cigna of CA PPO |
$4,104.04
|
| 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 |
$4,714.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,327.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,699.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$328.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.04
|
| 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 |
$4,436.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,604.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.10
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,773.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,773.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.00
|
| 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 ELB DISLOC W/ANEST
|
Facility
|
IP
|
$5,546.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,109.20 |
| Max. Negotiated Rate |
$4,714.10 |
| Rate for Payer: Adventist Health Commercial |
$1,109.20
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,218.40
|
| Rate for Payer: Galaxy Health WC |
$4,714.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,327.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,699.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,113.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,432.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.04
|
| Rate for Payer: Multiplan Commercial |
$4,436.80
|
| Rate for Payer: Networks By Design Commercial |
$3,604.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.10
|
|
|
HC CL TREAT OF ELBOW FRAC W/MANIP
|
Facility
|
IP
|
$6,826.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
900501359
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,365.20 |
| Max. Negotiated Rate |
$5,802.10 |
| Rate for Payer: Adventist Health Commercial |
$1,365.20
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,730.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,730.40
|
| Rate for Payer: Galaxy Health WC |
$5,802.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,225.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.24
|
| Rate for Payer: Multiplan Commercial |
$5,460.80
|
| Rate for Payer: Networks By Design Commercial |
$4,436.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,802.10
|
|
|
HC CL TREAT OF ELBOW FRAC W/MANIP
|
Facility
|
OP
|
$6,826.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
900501359
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.02 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.20
|
| 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 |
$3,071.70
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Cigna of CA HMO |
$4,368.64
|
| Rate for Payer: Cigna of CA PPO |
$5,051.24
|
| 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 |
$5,802.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.24
|
| 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 |
$5,460.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,436.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,802.10
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,095.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,413.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,413.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,413.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,413.00
|
| 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 FRAC OF PHAL W/MAN
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
900501099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$1,480.70 |
| Rate for Payer: Adventist Health Commercial |
$348.40
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Senior |
$696.80
|
| Rate for Payer: Galaxy Health WC |
$1,480.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,045.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,161.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$663.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,078.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.08
|
| Rate for Payer: Multiplan Commercial |
$1,393.60
|
| Rate for Payer: Networks By Design Commercial |
$1,132.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,480.70
|
|
|
HC CL TREAT OF FRAC OF PHAL W/MAN
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
900501099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$348.40
|
| 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 |
$783.90
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cigna of CA HMO |
$1,114.88
|
| Rate for Payer: Cigna of CA PPO |
$1,289.08
|
| 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 |
$1,480.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,045.20
|
| 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 |
$1,161.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.08
|
| 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 |
$1,393.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,132.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,045.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$871.00
|
| Rate for Payer: United Healthcare All Other HMO |
$871.00
|
| Rate for Payer: United Healthcare HMO Rider |
$871.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.00
|
| 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 HEAD/NECK W/MANIPU
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.28 |
| 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 |
$439.28
|
| 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 HEAD/NECK W/MANIPU
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
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 HUM SHAFT FRAC
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$2,745.50 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.00
|
| Rate for Payer: Galaxy Health WC |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,230.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,999.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.20
|
| Rate for Payer: Multiplan Commercial |
$2,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
|
|
HC CL TREAT OF HUM SHAFT FRAC
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| 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 |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cigna of CA HMO |
$2,067.20
|
| Rate for Payer: Cigna of CA PPO |
$2,390.20
|
| 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 |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| 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 |
$2,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.20
|
| 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 |
$2,584.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,938.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,615.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,615.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,615.00
|
| 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 INTPHAL JOINT SIN
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$378.20
|
| 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 |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cigna of CA HMO |
$1,210.24
|
| Rate for Payer: Cigna of CA PPO |
$1,399.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| 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 |
$1,261.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$945.50
|
| Rate for Payer: United Healthcare All Other HMO |
$945.50
|
| Rate for Payer: United Healthcare HMO Rider |
$945.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$945.50
|
| 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 INTPHAL JOINT SIN
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.20 |
| Max. Negotiated Rate |
$1,607.35 |
| Rate for Payer: Adventist Health Commercial |
$378.20
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$756.40
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,261.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$720.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,170.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
|
|
HC CL TREAT OF INTRPHAL JONT DISL
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
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 OF INTRPHAL JONT DISL
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,048.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.19
|
| 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 OF KNEE DISC W/ANESTH
|
Facility
|
IP
|
$3,813.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
900501087
|
|
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: Blue Shield of California Commercial |
$2,813.99
|
| Rate for Payer: Blue Shield of California EPN |
$1,853.12
|
| 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 OF KNEE DISC W/ANESTH
|
Facility
|
OP
|
$3,813.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
900501087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$762.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,715.85
|
| 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 Medi-Cal |
$499.40
|
| 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 OF META FRAC SIN W/O
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
|
|
HC CL TREAT OF META FRAC SIN W/O
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$587.12 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,457.92
|
| Rate for Payer: Cigna of CA PPO |
$3,998.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,701.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,701.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,701.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
|
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.60 |
| Max. Negotiated Rate |
$1,413.55 |
| Rate for Payer: Adventist Health Commercial |
$332.60
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.20
|
| Rate for Payer: EPIC Health Plan Senior |
$665.20
|
| Rate for Payer: Galaxy Health WC |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,109.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,029.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| Rate for Payer: Multiplan Commercial |
$1,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
|
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.45 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$332.60
|
| 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 |
$748.35
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cigna of CA HMO |
$1,064.32
|
| Rate for Payer: Cigna of CA PPO |
$1,230.62
|
| 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 |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| 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 |
$1,109.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| 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 |
$1,330.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$831.50
|
| Rate for Payer: United Healthcare All Other HMO |
$831.50
|
| Rate for Payer: United Healthcare HMO Rider |
$831.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$831.50
|
| 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 NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
IP
|
$4,665.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$933.00 |
| Max. Negotiated Rate |
$3,965.25 |
| Rate for Payer: Adventist Health Commercial |
$933.00
|
| Rate for Payer: Cash Price |
$2,099.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,866.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,866.00
|
| Rate for Payer: Galaxy Health WC |
$3,965.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,799.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,111.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,777.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,887.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,119.60
|
| Rate for Payer: Multiplan Commercial |
$3,732.00
|
| Rate for Payer: Networks By Design Commercial |
$3,032.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,965.25
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
OP
|
$4,665.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$933.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,099.25
|
| Rate for Payer: Cash Price |
$2,099.25
|
| Rate for Payer: Cash Price |
$2,099.25
|
| Rate for Payer: Cigna of CA HMO |
$2,985.60
|
| Rate for Payer: Cigna of CA PPO |
$3,452.10
|
| 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 |
$3,965.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,799.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,111.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$3,732.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,032.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,965.25
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,799.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,332.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,332.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,332.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,332.50
|
| 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 OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
|
OP
|
$5,519.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,103.80
|
| 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 |
$2,483.55
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: Cigna of CA HMO |
$3,532.16
|
| Rate for Payer: Cigna of CA PPO |
$4,084.06
|
| 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 |
$4,691.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.40
|
| 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 |
$3,681.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.56
|
| 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 |
$4,415.20
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,587.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,691.15
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,311.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,759.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,759.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,759.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,759.50
|
| 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
|
|
