|
HC CL TREAT NASAL SEPTAL FX
|
Facility
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,309.60 |
| Max. Negotiated Rate |
$5,565.80 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,619.20
|
| Rate for Payer: Galaxy Health WC |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,863.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Multiplan Commercial |
$5,238.40
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
|
|
HC CL TREAT NASAL SEPTAL FX
|
Facility
|
OP
|
$6,548.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cigna of CA HMO |
$4,190.72
|
| Rate for Payer: Cigna of CA PPO |
$4,845.52
|
| 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 |
$4,583.60
|
| 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 |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| 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 |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| 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 |
$5,238.40
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,928.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,274.00
|
| 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 OF ACROMICLAV W/MANIP
|
Facility
|
IP
|
$4,774.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$954.80 |
| Max. Negotiated Rate |
$4,057.90 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,341.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,909.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,909.60
|
| Rate for Payer: Galaxy Health WC |
$4,057.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,864.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,031.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,816.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.76
|
| Rate for Payer: Multiplan Commercial |
$3,819.20
|
| Rate for Payer: Networks By Design Commercial |
$3,103.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,057.90
|
|
|
HC CL TREAT OF ACROMICLAV W/MANIP
|
Facility
|
OP
|
$4,774.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| 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 |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cigna of CA HMO |
$3,055.36
|
| Rate for Payer: Cigna of CA PPO |
$3,532.76
|
| 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 |
$3,341.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$4,057.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,864.40
|
| 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 |
$3,031.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$250.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,145.76
|
| 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 |
$3,819.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$3,103.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,057.90
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,864.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,387.00
|
| 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 OF CARPOMETACARPAL
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| 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 |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Cigna of CA HMO |
$1,900.80
|
| Rate for Payer: Cigna of CA PPO |
$2,197.80
|
| 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 |
$2,079.00
|
| 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 |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| 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 |
$1,885.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| 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 |
$2,376.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,782.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,485.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,485.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,485.00
|
| 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 OF CARPOMETACARPAL
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$594.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$594.00
|
| Rate for Payer: Cash Price |
$1,336.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,079.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,188.00
|
| Rate for Payer: Galaxy Health WC |
$2,524.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,782.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,885.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,752.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.80
|
| Rate for Payer: Multiplan Commercial |
$2,376.00
|
| Rate for Payer: Networks By Design Commercial |
$1,930.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,524.50
|
|
|
HC CL TREAT OF CLAV FRAC W/MANIPU
|
Facility
|
OP
|
$6,497.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$287.19 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,299.40
|
| 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 |
$2,923.65
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Cigna of CA HMO |
$4,158.08
|
| Rate for Payer: Cigna of CA PPO |
$4,807.78
|
| 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 |
$4,547.90
|
| 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 |
$5,522.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.20
|
| 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 |
$4,125.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.28
|
| 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 |
$5,197.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,223.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,522.45
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,898.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,248.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,248.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,248.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,248.50
|
| 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 CL TREAT OF CLAV FRAC W/MANIPU
|
Facility
|
IP
|
$6,497.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,299.40 |
| Max. Negotiated Rate |
$5,522.45 |
| Rate for Payer: Adventist Health Commercial |
$1,299.40
|
| Rate for Payer: Cash Price |
$2,923.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,547.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,598.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,598.80
|
| Rate for Payer: Galaxy Health WC |
$5,522.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,898.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,125.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,833.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,559.28
|
| Rate for Payer: Multiplan Commercial |
$5,197.60
|
| Rate for Payer: Networks By Design Commercial |
$4,223.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,522.45
|
|
|
HC CL TREAT OF CLAV FRAC W/O MANI
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| 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 |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cigna of CA HMO |
$968.32
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| 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 |
$1,059.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| 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 |
$960.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| 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 |
$1,210.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other HMO |
$756.50
|
| Rate for Payer: United Healthcare HMO Rider |
$756.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.50
|
| 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 OF CLAV FRAC W/O MANI
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,286.05 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,059.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$960.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$892.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
|
IP
|
$3,669.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$3,118.65 |
| Rate for Payer: Adventist Health Commercial |
$733.80
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,568.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,467.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,467.60
|
| Rate for Payer: Galaxy Health WC |
$3,118.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,201.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,329.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,164.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.56
|
| Rate for Payer: Multiplan Commercial |
$2,935.20
|
| Rate for Payer: Networks By Design Commercial |
$2,384.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,118.65
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
|
IP
|
$3,669.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$733.80 |
| Max. Negotiated Rate |
$3,118.65 |
| Rate for Payer: Adventist Health Commercial |
$733.80
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,568.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,467.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,467.60
|
| Rate for Payer: Galaxy Health WC |
$3,118.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,201.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,329.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,164.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.56
|
| Rate for Payer: Multiplan Commercial |
$2,935.20
|
| Rate for Payer: Networks By Design Commercial |
$2,384.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,118.65
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
|
OP
|
$3,669.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$515.68 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$3,118.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,201.40
|
| 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 |
$2,329.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.56
|
| 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 |
$2,935.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,384.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,118.65
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,201.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,834.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,834.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,834.50
|
| 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
|
| Rate for Payer: Adventist Health Commercial |
$733.80
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cigna of CA HMO |
$2,348.16
|
| Rate for Payer: Cigna of CA PPO |
$2,715.06
|
| 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 |
$2,568.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
|
OP
|
$3,669.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,504.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,707.82
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cash Price |
$1,651.05
|
| Rate for Payer: Cigna of CA HMO |
$2,348.16
|
| Rate for Payer: Cigna of CA PPO |
$2,715.06
|
| 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 |
$2,568.30
|
| 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 |
$3,118.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,201.40
|
| 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 |
$2,329.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$515.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.56
|
| 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 |
$2,935.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,384.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,118.65
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,201.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,201.40
|
| 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 OF DIS RAD FX W/O MAN
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.20 |
| Max. Negotiated Rate |
$1,607.35 |
| Rate for Payer: Adventist Health Commercial |
$378.20
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,323.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$756.40
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,200.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,115.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
|
|
HC CL TREAT OF DIS RAD FX W/O MAN
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$378.20 |
| Max. Negotiated Rate |
$1,607.35 |
| Rate for Payer: Adventist Health Commercial |
$378.20
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,323.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$756.40
|
| Rate for Payer: EPIC Health Plan Senior |
$756.40
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,200.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,115.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| Rate for Payer: Multiplan Commercial |
$1,512.80
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
|
|
HC CL TREAT OF DIS RAD FX W/O MAN
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$775.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,669.43
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cigna of CA HMO |
$1,210.24
|
| Rate for Payer: Cigna of CA PPO |
$1,399.34
|
| 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 |
$1,323.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| 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 |
$1,200.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| 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 |
$1,512.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,134.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,134.60
|
| 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 OF DIS RAD FX W/O MAN
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$378.20
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cash Price |
$850.95
|
| Rate for Payer: Cigna of CA HMO |
$1,210.24
|
| Rate for Payer: Cigna of CA PPO |
$1,399.34
|
| 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 |
$1,323.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,607.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,134.60
|
| 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 |
$1,200.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$453.84
|
| 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 |
$1,512.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,229.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,607.35
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,134.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$945.50
|
| Rate for Payer: United Healthcare All Other HMO |
$945.50
|
| Rate for Payer: United Healthcare HMO Rider |
$945.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$945.50
|
| 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 OF ELB DISLOC W/ANEST
|
Facility
|
IP
|
$5,546.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,109.20 |
| Max. Negotiated Rate |
$4,714.10 |
| Rate for Payer: Adventist Health Commercial |
$1,109.20
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,218.40
|
| Rate for Payer: Galaxy Health WC |
$4,714.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,327.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,521.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.04
|
| Rate for Payer: Multiplan Commercial |
$4,436.80
|
| Rate for Payer: Networks By Design Commercial |
$3,604.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.10
|
|
|
HC CL TREAT OF ELB DISLOC W/ANEST
|
Facility
|
IP
|
$5,546.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,109.20 |
| Max. Negotiated Rate |
$4,714.10 |
| Rate for Payer: Adventist Health Commercial |
$1,109.20
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,882.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,218.40
|
| Rate for Payer: Galaxy Health WC |
$4,714.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,327.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,521.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,272.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.04
|
| Rate for Payer: Multiplan Commercial |
$4,436.80
|
| Rate for Payer: Networks By Design Commercial |
$3,604.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.10
|
|
|
HC CL TREAT OF ELB DISLOC W/ANEST
|
Facility
|
OP
|
$5,546.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$328.93 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$2,273.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,958.58
|
| 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 |
$2,495.70
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Cigna of CA HMO |
$3,549.44
|
| Rate for Payer: Cigna of CA PPO |
$4,104.04
|
| 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 |
$3,882.20
|
| 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 |
$4,714.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,327.60
|
| 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 |
$3,521.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.04
|
| 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 |
$4,436.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,604.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.10
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,327.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,327.60
|
| 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 |
$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 OF ELB DISLOC W/ANEST
|
Facility
|
OP
|
$5,546.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$328.93 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,109.20
|
| 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 |
$2,495.70
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Cash Price |
$2,495.70
|
| Rate for Payer: Cigna of CA HMO |
$3,549.44
|
| Rate for Payer: Cigna of CA PPO |
$4,104.04
|
| 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 |
$3,882.20
|
| 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 |
$4,714.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,327.60
|
| 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 |
$3,521.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,331.04
|
| 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 |
$4,436.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,604.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,714.10
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,327.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,773.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,773.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,773.00
|
| 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 OF ELBOW FRAC W/MANIP
|
Facility
|
IP
|
$6,826.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
900501359
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,365.20 |
| Max. Negotiated Rate |
$5,802.10 |
| Rate for Payer: Adventist Health Commercial |
$1,365.20
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,778.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,730.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,730.40
|
| Rate for Payer: Galaxy Health WC |
$5,802.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,334.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,027.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.24
|
| Rate for Payer: Multiplan Commercial |
$5,460.80
|
| Rate for Payer: Networks By Design Commercial |
$4,436.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,802.10
|
|
|
HC CL TREAT OF ELBOW FRAC W/MANIP
|
Facility
|
OP
|
$6,826.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
900501359
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$435.02 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,365.20
|
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Cigna of CA HMO |
$4,368.64
|
| Rate for Payer: Cigna of CA PPO |
$5,051.24
|
| 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 |
$4,778.20
|
| 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 |
$5,802.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.60
|
| 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 |
$4,334.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.24
|
| 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 |
$5,460.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,436.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,802.10
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,095.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,413.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,413.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,413.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,413.00
|
| 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 OF FRAC OF PHAL W/MAN
|
Facility
|
OP
|
$1,742.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
900501099
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$714.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$917.34
|
| 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 |
$783.90
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Cigna of CA HMO |
$1,114.88
|
| Rate for Payer: Cigna of CA PPO |
$1,289.08
|
| 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 |
$1,219.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,480.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,045.20
|
| 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 |
$1,106.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.08
|
| 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 |
$1,393.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,132.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,480.70
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,045.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,045.20
|
| 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
|
|
