|
HC CL TREAT OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
|
IP
|
$5,519.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,103.80 |
| Max. Negotiated Rate |
$4,691.15 |
| Rate for Payer: Adventist Health Commercial |
$1,103.80
|
| Rate for Payer: Cash Price |
$2,483.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,207.60
|
| Rate for Payer: Galaxy Health WC |
$4,691.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,311.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,681.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,102.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,416.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.56
|
| Rate for Payer: Multiplan Commercial |
$4,415.20
|
| Rate for Payer: Networks By Design Commercial |
$3,587.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,691.15
|
|
|
HC CL TREAT OF PAT DISC W/ANESTH
|
Facility
|
IP
|
$4,616.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.20 |
| Max. Negotiated Rate |
$3,923.60 |
| Rate for Payer: Adventist Health Commercial |
$923.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,406.61
|
| Rate for Payer: Blue Shield of California EPN |
$2,243.38
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,846.40
|
| Rate for Payer: Galaxy Health WC |
$3,923.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,769.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,078.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,758.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,857.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.84
|
| Rate for Payer: Multiplan Commercial |
$3,692.80
|
| Rate for Payer: Networks By Design Commercial |
$3,000.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,923.60
|
|
|
HC CL TREAT OF PAT DISC W/ANESTH
|
Facility
|
OP
|
$4,616.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$923.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$2,077.20
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: Cigna of CA HMO |
$2,954.24
|
| Rate for Payer: Cigna of CA PPO |
$3,415.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$3,923.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,769.60
|
| 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 |
$3,078.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.84
|
| 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 |
$3,692.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$3,000.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,923.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,769.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,308.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,308.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,308.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,308.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PAT DISC W/O ANEST
|
Facility
|
OP
|
$1,838.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
900501088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$367.60
|
| 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 |
$827.10
|
| Rate for Payer: Cash Price |
$827.10
|
| Rate for Payer: Cash Price |
$827.10
|
| Rate for Payer: Cigna of CA HMO |
$1,176.32
|
| Rate for Payer: Cigna of CA PPO |
$1,360.12
|
| 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 |
$1,562.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,102.80
|
| 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 |
$1,225.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$383.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.12
|
| 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 |
$1,470.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,194.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,562.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,102.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$919.00
|
| Rate for Payer: United Healthcare All Other HMO |
$919.00
|
| Rate for Payer: United Healthcare HMO Rider |
$919.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$919.00
|
| 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 PAT DISC W/O ANEST
|
Facility
|
IP
|
$1,838.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
900501088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.60 |
| Max. Negotiated Rate |
$1,562.30 |
| Rate for Payer: Adventist Health Commercial |
$367.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,356.44
|
| Rate for Payer: Blue Shield of California EPN |
$893.27
|
| Rate for Payer: Cash Price |
$827.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$735.20
|
| Rate for Payer: EPIC Health Plan Senior |
$735.20
|
| Rate for Payer: Galaxy Health WC |
$1,562.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,102.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,225.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$700.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,137.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$441.12
|
| Rate for Payer: Multiplan Commercial |
$1,470.40
|
| Rate for Payer: Networks By Design Commercial |
$1,194.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,562.30
|
|
|
HC CL TREAT OF PATELLAR FX,W/O MA
|
Facility
|
IP
|
$1,674.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.80 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Adventist Health Commercial |
$334.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,235.41
|
| Rate for Payer: Blue Shield of California EPN |
$813.56
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.60
|
| Rate for Payer: EPIC Health Plan Senior |
$669.60
|
| Rate for Payer: Galaxy Health WC |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,116.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,036.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.76
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
|
|
HC CL TREAT OF PATELLAR FX,W/O MA
|
Facility
|
OP
|
$1,674.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$334.80
|
| 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 |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna of CA HMO |
$1,071.36
|
| Rate for Payer: Cigna of CA PPO |
$1,238.76
|
| 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 |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| 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 |
$1,116.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.76
|
| 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 |
$1,339.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,004.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$837.00
|
| Rate for Payer: United Healthcare HMO Rider |
$837.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.00
|
| 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 PROX HUM FRAC W/MA
|
Facility
|
OP
|
$5,369.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
900501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$410.27 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.80
|
| 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 |
$2,416.05
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: Cigna of CA HMO |
$3,436.16
|
| Rate for Payer: Cigna of CA PPO |
$3,973.06
|
| 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 |
$4,563.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,221.40
|
| 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 |
$3,581.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.56
|
| 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 |
$4,295.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,489.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,563.65
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,221.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,684.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,684.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,684.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,684.50
|
| 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 PROX HUM FRAC W/MA
|
Facility
|
IP
|
$5,369.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
900501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,073.80 |
| Max. Negotiated Rate |
$4,563.65 |
| Rate for Payer: Adventist Health Commercial |
$1,073.80
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,147.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,147.60
|
| Rate for Payer: Galaxy Health WC |
$4,563.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,581.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,045.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,323.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.56
|
| Rate for Payer: Multiplan Commercial |
$4,295.20
|
| Rate for Payer: Networks By Design Commercial |
$3,489.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,563.65
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
|
OP
|
$2,179.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.75 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| 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 |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: Cigna of CA HMO |
$1,394.56
|
| Rate for Payer: Cigna of CA PPO |
$1,612.46
|
| 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 |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| 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 |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| 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 |
$1,743.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,307.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,089.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,089.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,089.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,089.50
|
| 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 RAD ELBOW CHILD
|
Facility
|
IP
|
$2,179.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.80 |
| Max. Negotiated Rate |
$1,852.15 |
| Rate for Payer: Adventist Health Commercial |
$435.80
|
| Rate for Payer: Cash Price |
$980.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$871.60
|
| Rate for Payer: EPIC Health Plan Senior |
$871.60
|
| Rate for Payer: Galaxy Health WC |
$1,852.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,307.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,453.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$830.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,348.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$522.96
|
| Rate for Payer: Multiplan Commercial |
$1,743.20
|
| Rate for Payer: Networks By Design Commercial |
$1,416.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,852.15
|
|
|
HC CL TREAT OF RAD & ULN SHAFT FR
|
Facility
|
IP
|
$3,214.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$642.80 |
| Max. Negotiated Rate |
$2,731.90 |
| Rate for Payer: Adventist Health Commercial |
$642.80
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,285.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,285.60
|
| Rate for Payer: Galaxy Health WC |
$2,731.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,928.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,143.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,224.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,989.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$771.36
|
| Rate for Payer: Multiplan Commercial |
$2,571.20
|
| Rate for Payer: Networks By Design Commercial |
$2,089.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,731.90
|
|
|
HC CL TREAT OF RAD & ULN SHAFT FR
|
Facility
|
OP
|
$3,214.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$505.06 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$642.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cash Price |
$1,446.30
|
| Rate for Payer: Cigna of CA HMO |
$2,056.96
|
| Rate for Payer: Cigna of CA PPO |
$2,378.36
|
| 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 |
$2,731.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,928.40
|
| 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 |
$2,143.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$771.36
|
| 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 |
$2,571.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,089.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,731.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,928.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,607.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,607.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,607.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,607.00
|
| 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 SHLD DISLOC W/MANI
|
Facility
|
IP
|
$2,165.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$433.00 |
| Max. Negotiated Rate |
$1,840.25 |
| Rate for Payer: Adventist Health Commercial |
$433.00
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$866.00
|
| Rate for Payer: EPIC Health Plan Senior |
$866.00
|
| Rate for Payer: Galaxy Health WC |
$1,840.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,299.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,444.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$824.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,340.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.60
|
| Rate for Payer: Multiplan Commercial |
$1,732.00
|
| Rate for Payer: Networks By Design Commercial |
$1,407.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,840.25
|
|
|
HC CL TREAT OF SHLD DISLOC W/MANI
|
Facility
|
OP
|
$2,165.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.51 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$433.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cash Price |
$974.25
|
| Rate for Payer: Cigna of CA HMO |
$1,385.60
|
| Rate for Payer: Cigna of CA PPO |
$1,602.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,840.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,299.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,444.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$519.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,732.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,407.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,840.25
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,299.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,082.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,082.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,082.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,082.50
|
| 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 TIB SHFT FRAC W/WO
|
Facility
|
IP
|
$1,529.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
900501233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.80 |
| Max. Negotiated Rate |
$1,299.65 |
| Rate for Payer: Adventist Health Commercial |
$305.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,128.40
|
| Rate for Payer: Blue Shield of California EPN |
$743.09
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$611.60
|
| Rate for Payer: EPIC Health Plan Senior |
$611.60
|
| Rate for Payer: Galaxy Health WC |
$1,299.65
|
| Rate for Payer: Global Benefits Group Commercial |
$917.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,019.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$582.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$946.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.96
|
| Rate for Payer: Multiplan Commercial |
$1,223.20
|
| Rate for Payer: Networks By Design Commercial |
$993.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,299.65
|
|
|
HC CL TREAT OF TIB SHFT FRAC W/WO
|
Facility
|
OP
|
$1,529.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
900501233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$305.80
|
| 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 |
$688.05
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Cash Price |
$688.05
|
| Rate for Payer: Cigna of CA HMO |
$978.56
|
| Rate for Payer: Cigna of CA PPO |
$1,131.46
|
| 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 |
$1,299.65
|
| Rate for Payer: Global Benefits Group Commercial |
$917.40
|
| 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 |
$1,019.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.96
|
| 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 |
$1,223.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$993.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,299.65
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$917.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.50
|
| Rate for Payer: United Healthcare All Other HMO |
$764.50
|
| Rate for Payer: United Healthcare HMO Rider |
$764.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$764.50
|
| 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 TM DIS INT OR SUBQ
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.41 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| 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 |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| 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 |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| 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 |
$975.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.88
|
| 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 |
$1,169.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$731.00
|
| Rate for Payer: United Healthcare All Other HMO |
$731.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$731.00
|
| 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 TM DIS INT OR SUBQ
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,242.70 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$975.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$557.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$904.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.88
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC CL TREAT OF ULN SHAFT FRAC W/O
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.75 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$921.60
|
| Rate for Payer: Cigna of CA PPO |
$1,065.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Other HMO |
$720.00
|
| Rate for Payer: United Healthcare HMO Rider |
$720.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT OF ULN SHAFT FRAC W/O
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
|
|
HC CL TREAT OF WRIST DISLOCATION
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$1,031.90 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$751.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
|
|
HC CL TREAT OF WRIST DISLOCATION
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| 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 |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna of CA HMO |
$776.96
|
| Rate for Payer: Cigna of CA PPO |
$898.36
|
| 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 |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| 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 |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$728.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.00
|
| Rate for Payer: United Healthcare All Other HMO |
$607.00
|
| Rate for Payer: United Healthcare HMO Rider |
$607.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$607.00
|
| 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 PHAL SHFT FX W/MANI
|
Facility
|
IP
|
$2,137.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.40 |
| Max. Negotiated Rate |
$1,816.45 |
| Rate for Payer: Adventist Health Commercial |
$427.40
|
| Rate for Payer: Cash Price |
$961.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$854.80
|
| Rate for Payer: EPIC Health Plan Senior |
$854.80
|
| Rate for Payer: Galaxy Health WC |
$1,816.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,282.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,425.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,322.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.88
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: Networks By Design Commercial |
$1,389.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,816.45
|
|
|
HC CL TREAT PHAL SHFT FX W/MANI
|
Facility
|
OP
|
$2,137.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$427.40
|
| 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 |
$961.65
|
| Rate for Payer: Cash Price |
$961.65
|
| Rate for Payer: Cash Price |
$961.65
|
| Rate for Payer: Cigna of CA HMO |
$1,367.68
|
| Rate for Payer: Cigna of CA PPO |
$1,581.38
|
| 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 |
$1,816.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,282.20
|
| 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 |
$1,425.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.88
|
| 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 |
$1,709.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,389.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,816.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,282.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,068.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,068.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,068.50
|
| 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
|
|
