|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
IP
|
$3,531.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$706.20 |
| Max. Negotiated Rate |
$3,001.35 |
| Rate for Payer: Adventist Health Commercial |
$706.20
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,471.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,412.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,412.40
|
| Rate for Payer: Galaxy Health WC |
$3,001.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,118.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,242.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,083.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.44
|
| Rate for Payer: Multiplan Commercial |
$2,824.80
|
| Rate for Payer: Networks By Design Commercial |
$2,295.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,001.35
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
OP
|
$3,531.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$706.20 |
| Max. Negotiated Rate |
$6,943.76 |
| Rate for Payer: Adventist Health Commercial |
$706.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cash Price |
$1,588.95
|
| Rate for Payer: Cigna of CA HMO |
$2,259.84
|
| Rate for Payer: Cigna of CA PPO |
$2,612.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,471.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$3,001.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,118.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,242.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$756.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$847.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$2,824.80
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$2,295.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,001.35
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,118.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,765.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,765.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,765.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,765.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
OP
|
$956.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Cigna of CA HMO |
$611.84
|
| Rate for Payer: Cigna of CA PPO |
$707.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$307.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$478.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$478.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$478.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
IP
|
$956.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$812.60 |
| Rate for Payer: Adventist Health Commercial |
$191.20
|
| Rate for Payer: Cash Price |
$430.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$669.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.40
|
| Rate for Payer: EPIC Health Plan Senior |
$382.40
|
| Rate for Payer: Galaxy Health WC |
$812.60
|
| Rate for Payer: Global Benefits Group Commercial |
$573.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$607.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$564.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.44
|
| Rate for Payer: Multiplan Commercial |
$764.80
|
| Rate for Payer: Networks By Design Commercial |
$621.40
|
| Rate for Payer: Prime Health Services Commercial |
$812.60
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
OP
|
$1,601.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.94 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Cigna of CA HMO |
$1,024.64
|
| Rate for Payer: Cigna of CA PPO |
$1,184.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$960.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$800.50
|
| Rate for Payer: United Healthcare All Other HMO |
$800.50
|
| Rate for Payer: United Healthcare HMO Rider |
$800.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$800.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
IP
|
$1,601.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.20 |
| Max. Negotiated Rate |
$1,360.85 |
| Rate for Payer: Adventist Health Commercial |
$320.20
|
| Rate for Payer: Cash Price |
$720.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$640.40
|
| Rate for Payer: EPIC Health Plan Senior |
$640.40
|
| Rate for Payer: Galaxy Health WC |
$1,360.85
|
| Rate for Payer: Global Benefits Group Commercial |
$960.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,016.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$944.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$384.24
|
| Rate for Payer: Multiplan Commercial |
$1,280.80
|
| Rate for Payer: Networks By Design Commercial |
$1,040.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,360.85
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$445.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Cigna of CA HMO |
$1,425.28
|
| Rate for Payer: Cigna of CA PPO |
$1,647.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,558.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$1,892.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,414.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.95
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,336.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,113.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,113.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,113.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$445.40 |
| Max. Negotiated Rate |
$1,892.95 |
| Rate for Payer: Adventist Health Commercial |
$445.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,129.09
|
| Rate for Payer: Blue Shield of California Commercial |
$1,712.56
|
| Rate for Payer: Cash Price |
$1,002.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,558.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$890.80
|
| Rate for Payer: EPIC Health Plan Senior |
$890.80
|
| Rate for Payer: Galaxy Health WC |
$1,892.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,336.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,414.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,313.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$534.48
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: Networks By Design Commercial |
$1,447.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,892.95
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Adventist Health Commercial |
$16.60
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$38.26
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Blue Shield of California Commercial |
$57.85
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$53.12
|
| Rate for Payer: Cigna of CA PPO |
$61.42
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$70.55
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$49.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$53.95
|
| Rate for Payer: Prime Health Services Commercial |
$70.55
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$92.77 |
| Rate for Payer: Adventist Health Commercial |
$16.60
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.77
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$38.26
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Blue Shield of California Commercial |
$57.85
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$53.12
|
| Rate for Payer: Cigna of CA PPO |
$61.42
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$70.55
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$49.80
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$53.95
|
| Rate for Payer: Prime Health Services Commercial |
$70.55
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$612.56
|
| Rate for Payer: Blue Shield of California Commercial |
$513.08
|
| Rate for Payer: Blue Shield of California Commercial |
$778.23
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,720.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,229.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,720.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
OP
|
$789.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Cigna of CA HMO |
$504.96
|
| Rate for Payer: Cigna of CA PPO |
$583.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$552.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$670.65
|
| Rate for Payer: Global Benefits Group Commercial |
$473.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$501.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$512.85
|
| Rate for Payer: Prime Health Services Commercial |
$670.65
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$473.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$394.50
|
| Rate for Payer: United Healthcare All Other HMO |
$394.50
|
| Rate for Payer: United Healthcare HMO Rider |
$394.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
IP
|
$789.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.80 |
| Max. Negotiated Rate |
$670.65 |
| Rate for Payer: Adventist Health Commercial |
$157.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.02
|
| Rate for Payer: Blue Shield of California Commercial |
$606.74
|
| Rate for Payer: Cash Price |
$355.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$552.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$315.60
|
| Rate for Payer: EPIC Health Plan Senior |
$315.60
|
| Rate for Payer: Galaxy Health WC |
$670.65
|
| Rate for Payer: Global Benefits Group Commercial |
$473.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$501.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$465.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.36
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: Networks By Design Commercial |
$512.85
|
| Rate for Payer: Prime Health Services Commercial |
$670.65
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$2,077.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.40 |
| Max. Negotiated Rate |
$1,765.45 |
| Rate for Payer: Adventist Health Commercial |
$415.40
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,453.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.80
|
| Rate for Payer: EPIC Health Plan Senior |
$830.80
|
| Rate for Payer: Galaxy Health WC |
$1,765.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,318.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,225.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.48
|
| Rate for Payer: Multiplan Commercial |
$1,661.60
|
| Rate for Payer: Networks By Design Commercial |
$1,350.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,765.45
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$2,077.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,765.45
|
| Rate for Payer: Adventist Health Commercial |
$415.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cigna of CA HMO |
$1,329.28
|
| Rate for Payer: Cigna of CA PPO |
$1,536.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,453.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,318.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,661.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,350.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,765.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,038.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,038.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,038.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,038.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$2,077.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$415.40 |
| Max. Negotiated Rate |
$1,765.45 |
| Rate for Payer: Adventist Health Commercial |
$415.40
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,453.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$830.80
|
| Rate for Payer: EPIC Health Plan Senior |
$830.80
|
| Rate for Payer: Galaxy Health WC |
$1,765.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,318.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,225.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.48
|
| Rate for Payer: Multiplan Commercial |
$1,661.60
|
| Rate for Payer: Networks By Design Commercial |
$1,350.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,765.45
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$2,077.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$851.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,398.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cash Price |
$934.65
|
| Rate for Payer: Cigna of CA HMO |
$1,329.28
|
| Rate for Payer: Cigna of CA PPO |
$1,536.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,453.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,765.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,246.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,318.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$365.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$498.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,661.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,350.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,765.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,246.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,246.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
IP
|
$1,591.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$318.20 |
| Max. Negotiated Rate |
$1,352.35 |
| Rate for Payer: Adventist Health Commercial |
$318.20
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,113.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$636.40
|
| Rate for Payer: Galaxy Health WC |
$1,352.35
|
| Rate for Payer: Global Benefits Group Commercial |
$954.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,010.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$938.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.84
|
| Rate for Payer: Multiplan Commercial |
$1,272.80
|
| Rate for Payer: Networks By Design Commercial |
$1,034.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,352.35
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
OP
|
$1,591.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$318.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cash Price |
$715.95
|
| Rate for Payer: Cigna of CA HMO |
$1,018.24
|
| Rate for Payer: Cigna of CA PPO |
$1,177.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,113.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,352.35
|
| Rate for Payer: Global Benefits Group Commercial |
$954.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,010.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,272.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,034.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,352.35
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$954.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$795.50
|
| Rate for Payer: United Healthcare All Other HMO |
$795.50
|
| Rate for Payer: United Healthcare HMO Rider |
$795.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$795.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT ANKLE DISCLOC W/ANES
|
Facility
|
IP
|
$4,616.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$923.20 |
| Max. Negotiated Rate |
$3,923.60 |
| Rate for Payer: Adventist Health Commercial |
$923.20
|
| Rate for Payer: Cash Price |
$2,077.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,846.40
|
| Rate for Payer: Galaxy Health WC |
$3,923.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,769.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,931.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,723.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,107.84
|
| Rate for Payer: Multiplan Commercial |
$3,692.80
|
| Rate for Payer: Networks By Design Commercial |
$3,000.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,923.60
|
|
