|
HC CL TREAT TRIMALLOR FX W/MANIPU
|
Facility
|
OP
|
$3,721.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
900501094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$744.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$744.20
|
| 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 |
$1,674.45
|
| Rate for Payer: Cash Price |
$1,674.45
|
| Rate for Payer: Cash Price |
$1,674.45
|
| Rate for Payer: Cigna of CA HMO |
$2,381.44
|
| Rate for Payer: Cigna of CA PPO |
$2,753.54
|
| 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 |
$3,162.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,232.60
|
| 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 |
$2,481.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$2,976.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,418.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,162.85
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,232.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,860.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,860.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,860.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,860.50
|
| 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 TRIMALLOR FX W/MANIPU
|
Facility
|
IP
|
$3,721.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
900501094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$744.20 |
| Max. Negotiated Rate |
$3,162.85 |
| Rate for Payer: Adventist Health Commercial |
$744.20
|
| Rate for Payer: Cash Price |
$1,674.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,488.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,488.40
|
| Rate for Payer: Galaxy Health WC |
$3,162.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,232.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,481.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,417.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,303.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$893.04
|
| Rate for Payer: Multiplan Commercial |
$2,976.80
|
| Rate for Payer: Networks By Design Commercial |
$2,418.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,162.85
|
|
|
HC CL TREAT TROCHANTERIC FX WO MAN
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
900527246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| 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 |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| 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 |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| 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 |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| 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 |
$777.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$486.00
|
| Rate for Payer: United Healthcare All Other HMO |
$486.00
|
| Rate for Payer: United Healthcare HMO Rider |
$486.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.00
|
| 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 TROCHANTERIC FX WO MAN
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
900527246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC CL TREAT ULNAR FX,PROXIMAL END
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
900501467
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$1,161.95 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$546.80
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$846.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
|
|
HC CL TREAT ULNAR FX,PROXIMAL END
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
900501467
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cigna of CA HMO |
$874.88
|
| Rate for Payer: Cigna of CA PPO |
$1,011.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$820.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.50
|
| Rate for Payer: United Healthcare All Other HMO |
$683.50
|
| Rate for Payer: United Healthcare HMO Rider |
$683.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT ULNAR FX, W/MANIPULAT
|
Facility
|
OP
|
$1,785.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$357.00
|
| 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 |
$803.25
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,320.90
|
| 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 |
$1,517.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.00
|
| 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 |
$1,190.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| 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 |
$1,428.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,517.25
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,071.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$892.50
|
| Rate for Payer: United Healthcare All Other HMO |
$892.50
|
| Rate for Payer: United Healthcare HMO Rider |
$892.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$892.50
|
| 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 ULNAR FX, W/MANIPULAT
|
Facility
|
IP
|
$1,785.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$357.00 |
| Max. Negotiated Rate |
$1,517.25 |
| Rate for Payer: Adventist Health Commercial |
$357.00
|
| Rate for Payer: Cash Price |
$803.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$714.00
|
| Rate for Payer: EPIC Health Plan Senior |
$714.00
|
| Rate for Payer: Galaxy Health WC |
$1,517.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,190.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$680.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,104.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$428.40
|
| Rate for Payer: Multiplan Commercial |
$1,428.00
|
| Rate for Payer: Networks By Design Commercial |
$1,160.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,517.25
|
|
|
HC CL TREAT ULNAR SHAFT FX W/MANI
|
Facility
|
OP
|
$1,950.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| 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 |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: Cigna of CA HMO |
$1,248.00
|
| Rate for Payer: Cigna of CA PPO |
$1,443.00
|
| 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 |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| 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 |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$975.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$975.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$975.00
|
| 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 ULNAR SHAFT FX W/MANI
|
Facility
|
IP
|
$1,950.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Adventist Health Commercial |
$390.00
|
| Rate for Payer: Cash Price |
$877.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$780.00
|
| Rate for Payer: EPIC Health Plan Senior |
$780.00
|
| Rate for Payer: Galaxy Health WC |
$1,657.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,170.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$742.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,207.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: Networks By Design Commercial |
$1,267.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,657.50
|
|
|
HC CL TREAT ULNAR STYLOID FX
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$1,161.95 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$546.80
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$846.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
|
|
HC CL TREAT ULNAR STYLOID FX
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cigna of CA HMO |
$874.88
|
| Rate for Payer: Cigna of CA PPO |
$1,011.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$820.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.50
|
| Rate for Payer: United Healthcare All Other HMO |
$683.50
|
| Rate for Payer: United Healthcare HMO Rider |
$683.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT VERTEBRAL BODY FX W/O
|
Facility
|
OP
|
$1,139.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$227.80
|
| 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 |
$512.55
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: Cigna of CA HMO |
$728.96
|
| Rate for Payer: Cigna of CA PPO |
$842.86
|
| 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 |
$968.15
|
| Rate for Payer: Global Benefits Group Commercial |
$683.40
|
| 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 |
$759.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.36
|
| 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 |
$911.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$740.35
|
| Rate for Payer: Prime Health Services Commercial |
$968.15
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$683.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other HMO |
$569.50
|
| Rate for Payer: United Healthcare HMO Rider |
$569.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$569.50
|
| 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 VERTEBRAL BODY FX W/O
|
Facility
|
IP
|
$1,139.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.80 |
| Max. Negotiated Rate |
$968.15 |
| Rate for Payer: Adventist Health Commercial |
$227.80
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.60
|
| Rate for Payer: EPIC Health Plan Senior |
$455.60
|
| Rate for Payer: Galaxy Health WC |
$968.15
|
| Rate for Payer: Global Benefits Group Commercial |
$683.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.36
|
| Rate for Payer: Multiplan Commercial |
$911.20
|
| Rate for Payer: Networks By Design Commercial |
$740.35
|
| Rate for Payer: Prime Health Services Commercial |
$968.15
|
|
|
HC CL TREAT WRIST FX, W/MANIPULAT
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.40 |
| Max. Negotiated Rate |
$1,289.45 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$939.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Networks By Design Commercial |
$986.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
|
|
HC CL TREAT WRIST FX, W/MANIPULAT
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| 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 |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cigna of CA HMO |
$970.88
|
| Rate for Payer: Cigna of CA PPO |
$1,122.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| 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 |
$1,011.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$986.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$758.50
|
| Rate for Payer: United Healthcare All Other HMO |
$758.50
|
| Rate for Payer: United Healthcare HMO Rider |
$758.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.50
|
| 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 TRT FEM FX W/O MANIP PE NCK
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,048.52
|
| Rate for Payer: Kaiser Permanente of CA 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 TRT FEM FX W/O MANIP PE NCK
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
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 TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| 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 |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| 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 |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| 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 |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| 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 |
$777.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$486.00
|
| Rate for Payer: United Healthcare All Other HMO |
$486.00
|
| Rate for Payer: United Healthcare HMO Rider |
$486.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.00
|
| 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 TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$601.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,088.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,768.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.27 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| 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 |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,828.48
|
| Rate for Payer: Cigna of CA PPO |
$2,114.18
|
| 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 |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| 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 |
$1,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| 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 |
$2,285.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,428.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,428.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,428.50
|
| 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 TRT OF KNEE DISC W/O ANESTH
|
Facility
|
OP
|
$1,884.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$376.80
|
| 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 |
$847.80
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna of CA HMO |
$1,205.76
|
| Rate for Payer: Cigna of CA PPO |
$1,394.16
|
| 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 |
$1,601.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,130.40
|
| 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 |
$1,256.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.16
|
| 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 |
$1,507.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,224.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,601.40
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$942.00
|
| Rate for Payer: United Healthcare HMO Rider |
$942.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$942.00
|
| 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 TRT OF KNEE DISC W/O ANESTH
|
Facility
|
IP
|
$1,884.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.80 |
| Max. Negotiated Rate |
$1,601.40 |
| Rate for Payer: Adventist Health Commercial |
$376.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,390.39
|
| Rate for Payer: Blue Shield of California EPN |
$915.62
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$753.60
|
| Rate for Payer: Galaxy Health WC |
$1,601.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,256.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$717.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,166.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.16
|
| Rate for Payer: Multiplan Commercial |
$1,507.20
|
| Rate for Payer: Networks By Design Commercial |
$1,224.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,601.40
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
905353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
