|
HC CL TREAT POST HIP ARTHOPLAS
|
Facility
|
OP
|
$4,231.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
900501084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$175.43 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| 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 |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: Cigna of CA HMO |
$2,707.84
|
| Rate for Payer: Cigna of CA PPO |
$3,130.94
|
| 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 |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| 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 |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.44
|
| 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 |
$3,384.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,538.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,115.50
|
| 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 POST HIP ARTHOPLAS
|
Facility
|
IP
|
$4,231.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
900501084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$846.20 |
| Max. Negotiated Rate |
$3,596.35 |
| Rate for Payer: Adventist Health Commercial |
$846.20
|
| Rate for Payer: Cash Price |
$1,903.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,692.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.40
|
| Rate for Payer: Galaxy Health WC |
$3,596.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,538.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,822.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,612.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,618.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,015.44
|
| Rate for Payer: Multiplan Commercial |
$3,384.80
|
| Rate for Payer: Networks By Design Commercial |
$2,750.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,596.35
|
|
|
HC CL TREAT POST HIP ARTH W/O ANE
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$1,288.60 |
| Rate for Payer: Adventist Health Commercial |
$303.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.40
|
| Rate for Payer: EPIC Health Plan Senior |
$606.40
|
| Rate for Payer: Galaxy Health WC |
$1,288.60
|
| Rate for Payer: Global Benefits Group Commercial |
$909.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$938.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.84
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: Networks By Design Commercial |
$985.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.60
|
|
|
HC CL TREAT POST HIP ARTH W/O ANE
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$303.20
|
| 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 |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cash Price |
$682.20
|
| Rate for Payer: Cigna of CA HMO |
$970.24
|
| Rate for Payer: Cigna of CA PPO |
$1,121.84
|
| 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 |
$1,288.60
|
| Rate for Payer: Global Benefits Group Commercial |
$909.60
|
| 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 |
$1,011.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.84
|
| 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 |
$1,212.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$985.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,288.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$758.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.00
|
| 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 PROXIMAL HUMERAL FX
|
Facility
|
IP
|
$1,782.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$356.40 |
| Max. Negotiated Rate |
$1,514.70 |
| Rate for Payer: Adventist Health Commercial |
$356.40
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.80
|
| Rate for Payer: EPIC Health Plan Senior |
$712.80
|
| Rate for Payer: Galaxy Health WC |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,103.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| Rate for Payer: Multiplan Commercial |
$1,425.60
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
|
|
HC CL TREAT PROXIMAL HUMERAL FX
|
Facility
|
OP
|
$1,782.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$356.40
|
| 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 |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cash Price |
$801.90
|
| Rate for Payer: Cigna of CA HMO |
$1,140.48
|
| Rate for Payer: Cigna of CA PPO |
$1,318.68
|
| 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 |
$1,514.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,069.20
|
| 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 |
$1,188.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.68
|
| 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 |
$1,425.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,158.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,514.70
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,069.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$891.00
|
| Rate for Payer: United Healthcare All Other HMO |
$891.00
|
| Rate for Payer: United Healthcare HMO Rider |
$891.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$891.00
|
| 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 RADIAL HEAD/NECK FX
|
Facility
|
IP
|
$1,515.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.00 |
| Max. Negotiated Rate |
$1,287.75 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.00
|
| Rate for Payer: EPIC Health Plan Senior |
$606.00
|
| Rate for Payer: Galaxy Health WC |
$1,287.75
|
| Rate for Payer: Global Benefits Group Commercial |
$909.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$937.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| Rate for Payer: Multiplan Commercial |
$1,212.00
|
| Rate for Payer: Networks By Design Commercial |
$984.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,287.75
|
|
|
HC CL TREAT RADIAL HEAD/NECK FX
|
Facility
|
OP
|
$1,515.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$303.00
|
| 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 |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cash Price |
$681.75
|
| Rate for Payer: Cigna of CA HMO |
$969.60
|
| Rate for Payer: Cigna of CA PPO |
$1,121.10
|
| 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 |
$1,287.75
|
| Rate for Payer: Global Benefits Group Commercial |
$909.00
|
| 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 |
$1,010.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.60
|
| 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 |
$1,212.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$984.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,287.75
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$909.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$757.50
|
| Rate for Payer: United Healthcare All Other HMO |
$757.50
|
| Rate for Payer: United Healthcare HMO Rider |
$757.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$757.50
|
| 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 RADIAL SHAFT FRX W/DI
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.40 |
| Max. Negotiated Rate |
$1,722.95 |
| Rate for Payer: Adventist Health Commercial |
$405.40
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.80
|
| Rate for Payer: EPIC Health Plan Senior |
$810.80
|
| Rate for Payer: Galaxy Health WC |
$1,722.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,216.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$772.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,254.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.48
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: Networks By Design Commercial |
$1,317.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.95
|
|
|
HC CL TREAT RADIAL SHAFT FRX W/DI
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$405.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Cigna of CA HMO |
$1,297.28
|
| Rate for Payer: Cigna of CA PPO |
$1,499.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$1,722.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,216.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,352.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,317.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.95
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,216.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,013.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,013.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,013.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,013.50
|
| 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 RADIAL SHAFT FX W/O M
|
Facility
|
IP
|
$1,964.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$1,669.40 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.60
|
| Rate for Payer: EPIC Health Plan Senior |
$785.60
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.36
|
| Rate for Payer: Multiplan Commercial |
$1,571.20
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
|
|
HC CL TREAT RADIAL SHAFT FX W/O M
|
Facility
|
OP
|
$1,964.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.31 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| 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 |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna of CA HMO |
$1,256.96
|
| Rate for Payer: Cigna of CA PPO |
$1,453.36
|
| 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 |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| 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 |
$1,309.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.36
|
| 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 |
$1,571.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,178.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$982.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$982.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$982.00
|
| 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 RADIOULNAR DIS W/MANI
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.20 |
| Max. Negotiated Rate |
$1,424.60 |
| Rate for Payer: Adventist Health Commercial |
$335.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.40
|
| Rate for Payer: EPIC Health Plan Senior |
$670.40
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
|
|
HC CL TREAT RADIOULNAR DIS W/MANI
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$335.20
|
| 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 |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna of CA HMO |
$1,072.64
|
| Rate for Payer: Cigna of CA PPO |
$1,240.24
|
| 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 |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| 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 |
$1,117.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$436.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| 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 |
$1,340.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$838.00
|
| Rate for Payer: United Healthcare All Other HMO |
$838.00
|
| Rate for Payer: United Healthcare HMO Rider |
$838.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$838.00
|
| 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 RADIUS/ULNA FX,W/O MA
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
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 RADIUS/ULNA FX,W/O MA
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$6,427.00 |
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,048.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$943.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other HMO |
$786.00
|
| Rate for Payer: United Healthcare HMO Rider |
$786.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT RAD SHAFT FRX W/MANIP
|
Facility
|
OP
|
$2,735.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.17 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$547.00
|
| 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 |
$1,230.75
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: Cigna of CA HMO |
$1,750.40
|
| Rate for Payer: Cigna of CA PPO |
$2,023.90
|
| 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 |
$2,324.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.00
|
| 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 |
$1,824.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$2,188.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,777.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,324.75
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.50
|
| 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 RAD SHAFT FRX W/MANIP
|
Facility
|
IP
|
$2,735.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$547.00 |
| Max. Negotiated Rate |
$2,324.75 |
| Rate for Payer: Adventist Health Commercial |
$547.00
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,094.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,094.00
|
| Rate for Payer: Galaxy Health WC |
$2,324.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,824.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,692.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.40
|
| Rate for Payer: Multiplan Commercial |
$2,188.00
|
| Rate for Payer: Networks By Design Commercial |
$1,777.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,324.75
|
|
|
HC CL TREAT SCAPULAR FX, W/O MANI
|
Facility
|
IP
|
$1,674.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
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: 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 SCAPULAR FX, W/O MANI
|
Facility
|
OP
|
$1,674.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.00 |
| 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 Medi-Cal |
$182.00
|
| 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 SC/TC HMRL FX W/MANIP
|
Facility
|
IP
|
$3,714.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.80 |
| Max. Negotiated Rate |
$3,156.90 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,485.60
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,415.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,298.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| Rate for Payer: Multiplan Commercial |
$2,971.20
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
|
|
HC CL TREAT SC/TC HMRL FX W/MANIP
|
Facility
|
OP
|
$3,714.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cigna of CA HMO |
$2,376.96
|
| Rate for Payer: Cigna of CA PPO |
$2,748.36
|
| 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 |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| 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 |
$2,477.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| 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 |
$2,971.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,228.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,857.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,857.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,857.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,857.00
|
| 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 SHLDR DISLOC W/ANES
|
Facility
|
OP
|
$6,365.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$5,410.25 |
| Rate for Payer: Adventist Health Commercial |
$1,273.00
|
| 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 |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cigna of CA HMO |
$4,073.60
|
| Rate for Payer: Cigna of CA PPO |
$4,710.10
|
| 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 |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| 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 |
$4,245.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| 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 |
$5,092.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,819.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,182.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,182.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,182.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,182.50
|
| 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 SHLDR DISLOC W/ANES
|
Facility
|
IP
|
$6,365.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,273.00 |
| Max. Negotiated Rate |
$5,410.25 |
| Rate for Payer: Adventist Health Commercial |
$1,273.00
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,546.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,546.00
|
| Rate for Payer: Galaxy Health WC |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,245.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,425.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,939.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
|
|
HC CL TREAT SHLDR DISLO/FX W/MANI
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
900501501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,453.50
|
| 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
|
|
