|
HC CL TREAT MANDIBULAR FX
|
Facility
|
IP
|
$15,378.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
900501369
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,075.60 |
| Max. Negotiated Rate |
$13,071.30 |
| Rate for Payer: EPIC Health Plan Senior |
$6,151.20
|
| Rate for Payer: Galaxy Health WC |
$13,071.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,151.20
|
| Rate for Payer: Adventist Health Commercial |
$3,075.60
|
| Rate for Payer: Cash Price |
$6,920.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,764.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,226.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,765.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,073.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,690.72
|
| Rate for Payer: Multiplan Commercial |
$12,302.40
|
| Rate for Payer: Networks By Design Commercial |
$9,995.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,071.30
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
|
IP
|
$13,308.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,661.60 |
| Max. Negotiated Rate |
$11,311.80 |
| Rate for Payer: Adventist Health Commercial |
$2,661.60
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,315.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,323.20
|
| Rate for Payer: Galaxy Health WC |
$11,311.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,984.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,450.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,851.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.92
|
| Rate for Payer: Multiplan Commercial |
$10,646.40
|
| Rate for Payer: Networks By Design Commercial |
$8,650.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,311.80
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
|
OP
|
$13,308.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$720.10 |
| Max. Negotiated Rate |
$11,311.80 |
| Rate for Payer: Adventist Health Commercial |
$2,661.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: Cash Price |
$5,988.60
|
| Rate for Payer: Cigna of CA HMO |
$8,517.12
|
| Rate for Payer: Cigna of CA PPO |
$9,847.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,315.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$11,311.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,984.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,450.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$720.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$10,646.40
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$8,650.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,311.80
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,984.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,654.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,654.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,654.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,654.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
|
OP
|
$5,936.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.53 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,187.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Cigna of CA HMO |
$3,799.04
|
| Rate for Payer: Cigna of CA PPO |
$4,392.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$5,045.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,561.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,769.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,858.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,045.60
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,561.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,968.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,968.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,968.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,968.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
|
IP
|
$5,936.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,187.20 |
| Max. Negotiated Rate |
$5,045.60 |
| Rate for Payer: Adventist Health Commercial |
$1,187.20
|
| Rate for Payer: Cash Price |
$2,671.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,374.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,374.40
|
| Rate for Payer: Galaxy Health WC |
$5,045.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,561.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,769.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,502.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.64
|
| Rate for Payer: Multiplan Commercial |
$4,748.80
|
| Rate for Payer: Networks By Design Commercial |
$3,858.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,045.60
|
|
|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
|
OP
|
$5,174.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$2,121.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,806.19
|
| 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 |
$2,328.30
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Cigna of CA HMO |
$3,311.36
|
| Rate for Payer: Cigna of CA PPO |
$3,828.76
|
| 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 |
$3,621.80
|
| 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 |
$4,397.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,104.40
|
| 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 |
$3,285.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.76
|
| 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 |
$4,139.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,363.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,104.40
|
| 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 |
$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 CL TREAT MED MALL FX W/MANIPUL
|
Facility
|
IP
|
$5,174.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,034.80 |
| Max. Negotiated Rate |
$4,397.90 |
| Rate for Payer: Adventist Health Commercial |
$1,034.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,623.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,978.81
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,621.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,069.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,069.60
|
| Rate for Payer: Galaxy Health WC |
$4,397.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,104.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,285.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,052.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.76
|
| Rate for Payer: Multiplan Commercial |
$4,139.20
|
| Rate for Payer: Networks By Design Commercial |
$3,363.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.90
|
|
|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
|
IP
|
$5,174.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,034.80 |
| Max. Negotiated Rate |
$4,397.90 |
| Rate for Payer: Adventist Health Commercial |
$1,034.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,623.22
|
| Rate for Payer: Blue Shield of California Commercial |
$3,978.81
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,621.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,069.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,069.60
|
| Rate for Payer: Galaxy Health WC |
$4,397.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,104.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,285.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,052.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.76
|
| Rate for Payer: Multiplan Commercial |
$4,139.20
|
| Rate for Payer: Networks By Design Commercial |
$3,363.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.90
|
|
|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
|
OP
|
$5,174.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.89 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Cigna of CA PPO |
$3,828.76
|
| 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 |
$3,621.80
|
| 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 |
$4,397.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,104.40
|
| 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 |
$3,285.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.76
|
| 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 |
$4,139.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,363.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,104.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,587.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,587.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,587.00
|
| 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
|
| Rate for Payer: Adventist Health Commercial |
$1,034.80
|
| 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 |
$2,328.30
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Cash Price |
$2,328.30
|
| Rate for Payer: Cigna of CA HMO |
$3,311.36
|
|
|
HC CL TREAT METACARPAL FX, SNGL
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| 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 |
$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 |
$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 |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| 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 |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| 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 |
$1,257.60
|
| 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 |
$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 METACARPAL FX, SNGL
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC CL TREAT METACARPAL FX, SNGL
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC CL TREAT METACARPAL FX, SNGL
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$644.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,704.47
|
| 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 |
$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 |
$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 |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| 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 |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| 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 |
$1,257.60
|
| 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: TriValley Medical Group Commercial/Senior |
$943.20
|
| 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 METACARPAL W/MANIPULA
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$264.56 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$678.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,838.72
|
| 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 |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna of CA HMO |
$1,059.84
|
| Rate for Payer: Cigna of CA PPO |
$1,225.44
|
| 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 |
$1,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,407.60
|
| Rate for Payer: Global Benefits Group Commercial |
$993.60
|
| 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 |
$1,051.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.44
|
| 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 |
$1,324.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,076.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$993.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$993.60
|
| 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 METACARPAL W/MANIPULA
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Adventist Health Commercial |
$331.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$662.40
|
| Rate for Payer: Galaxy Health WC |
$1,407.60
|
| Rate for Payer: Global Benefits Group Commercial |
$993.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,051.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.44
|
| Rate for Payer: Multiplan Commercial |
$1,324.80
|
| Rate for Payer: Networks By Design Commercial |
$1,076.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.60
|
|
|
HC CL TREAT METACARPAL W/MANIPULA
|
Facility
|
OP
|
$1,656.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.56 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$331.20
|
| 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 |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Cigna of CA HMO |
$1,059.84
|
| Rate for Payer: Cigna of CA PPO |
$1,225.44
|
| 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 |
$1,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,407.60
|
| Rate for Payer: Global Benefits Group Commercial |
$993.60
|
| 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 |
$1,051.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$264.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.44
|
| 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 |
$1,324.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,076.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$993.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$828.00
|
| Rate for Payer: United Healthcare All Other HMO |
$828.00
|
| Rate for Payer: United Healthcare HMO Rider |
$828.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.00
|
| 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 METACARPAL W/MANIPULA
|
Facility
|
IP
|
$1,656.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Adventist Health Commercial |
$331.20
|
| Rate for Payer: Cash Price |
$745.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,159.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Senior |
$662.40
|
| Rate for Payer: Galaxy Health WC |
$1,407.60
|
| Rate for Payer: Global Benefits Group Commercial |
$993.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,051.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$397.44
|
| Rate for Payer: Multiplan Commercial |
$1,324.80
|
| Rate for Payer: Networks By Design Commercial |
$1,076.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,407.60
|
|
|
HC CL TREAT META FX SNGL W/MAN
|
Facility
|
IP
|
$2,119.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$1,801.15 |
| Rate for Payer: Adventist Health Commercial |
$423.80
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,483.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$847.60
|
| Rate for Payer: EPIC Health Plan Senior |
$847.60
|
| Rate for Payer: Galaxy Health WC |
$1,801.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,271.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,345.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,250.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$1,695.20
|
| Rate for Payer: Networks By Design Commercial |
$1,377.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,801.15
|
|
|
HC CL TREAT META FX SNGL W/MAN
|
Facility
|
OP
|
$2,119.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$423.80
|
| 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 |
$953.55
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Cigna of CA HMO |
$1,356.16
|
| Rate for Payer: Cigna of CA PPO |
$1,568.06
|
| 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 |
$1,483.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,801.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,271.40
|
| 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 |
$1,345.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.56
|
| 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 |
$1,695.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,377.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,801.15
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,271.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,059.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,059.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,059.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,059.50
|
| 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 META FX SNGL W/MAN
|
Facility
|
IP
|
$2,119.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$1,801.15 |
| Rate for Payer: Adventist Health Commercial |
$423.80
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,483.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$847.60
|
| Rate for Payer: EPIC Health Plan Senior |
$847.60
|
| Rate for Payer: Galaxy Health WC |
$1,801.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,271.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,345.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,250.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.56
|
| Rate for Payer: Multiplan Commercial |
$1,695.20
|
| Rate for Payer: Networks By Design Commercial |
$1,377.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,801.15
|
|
|
HC CL TREAT META FX SNGL W/MAN
|
Facility
|
OP
|
$2,119.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$868.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,849.84
|
| 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 |
$953.55
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Cash Price |
$953.55
|
| Rate for Payer: Cigna of CA HMO |
$1,356.16
|
| Rate for Payer: Cigna of CA PPO |
$1,568.06
|
| 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 |
$1,483.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,801.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,271.40
|
| 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 |
$1,345.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$348.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$508.56
|
| 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 |
$1,695.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,377.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,801.15
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,271.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,271.40
|
| 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 META FX W/EXT FIX EA
|
Facility
|
OP
|
$6,174.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$772.45 |
| Max. Negotiated Rate |
$6,943.76 |
| Rate for Payer: Adventist Health Commercial |
$1,234.80
|
| 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 |
$2,778.30
|
| Rate for Payer: Cash Price |
$2,778.30
|
| Rate for Payer: Cash Price |
$2,778.30
|
| Rate for Payer: Cigna of CA HMO |
$3,951.36
|
| Rate for Payer: Cigna of CA PPO |
$4,568.76
|
| 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 |
$4,321.80
|
| 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 |
$5,247.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,704.40
|
| 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 |
$3,920.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$772.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.76
|
| 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 |
$4,939.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,013.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,247.90
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,704.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,087.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,087.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,087.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,087.00
|
| 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 CL TREAT META FX W/EXT FIX EA
|
Facility
|
IP
|
$6,174.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,234.80 |
| Max. Negotiated Rate |
$5,247.90 |
| Rate for Payer: Adventist Health Commercial |
$1,234.80
|
| Rate for Payer: Cash Price |
$2,778.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,321.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,469.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,469.60
|
| Rate for Payer: Galaxy Health WC |
$5,247.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,704.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,920.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,642.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,481.76
|
| Rate for Payer: Multiplan Commercial |
$4,939.20
|
| Rate for Payer: Networks By Design Commercial |
$4,013.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,247.90
|
|
|
HC CL TREAT MOUTH ROOF FX
|
Facility
|
IP
|
$4,717.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.40 |
| Max. Negotiated Rate |
$4,009.45 |
| Rate for Payer: EPIC Health Plan Senior |
$1,886.80
|
| Rate for Payer: Galaxy Health WC |
$4,009.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,886.80
|
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,301.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,830.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,995.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,132.08
|
| Rate for Payer: Multiplan Commercial |
$3,773.60
|
| Rate for Payer: Networks By Design Commercial |
$3,066.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,009.45
|
|
|
HC CL TREAT MOUTH ROOF FX
|
Facility
|
OP
|
$4,717.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$560.94 |
| Max. Negotiated Rate |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$943.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cash Price |
$2,122.65
|
| Rate for Payer: Cigna of CA HMO |
$3,018.88
|
| Rate for Payer: Cigna of CA PPO |
$3,490.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,301.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$4,009.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,830.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,995.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$560.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,132.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$3,773.60
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,066.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,009.45
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,830.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,358.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,358.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,358.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,358.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
