|
HC CL TREAT OF FRAC OF PHAL W/MAN
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
900501099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$1,480.70 |
| Rate for Payer: Adventist Health Commercial |
$348.40
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,219.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Senior |
$696.80
|
| Rate for Payer: Galaxy Health WC |
$1,480.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,045.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,106.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,027.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.08
|
| Rate for Payer: Multiplan Commercial |
$1,393.60
|
| Rate for Payer: Networks By Design Commercial |
$1,132.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,480.70
|
|
|
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
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$348.40
|
| 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 |
$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: United Healthcare All Other Commercial |
$871.00
|
| Rate for Payer: United Healthcare All Other HMO |
$871.00
|
| Rate for Payer: United Healthcare HMO Rider |
$871.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$871.00
|
| 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 FRAC OF PHAL W/MAN
|
Facility
|
IP
|
$1,742.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
900501099
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$1,480.70 |
| Rate for Payer: Adventist Health Commercial |
$348.40
|
| Rate for Payer: Cash Price |
$783.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,219.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$696.80
|
| Rate for Payer: EPIC Health Plan Senior |
$696.80
|
| Rate for Payer: Galaxy Health WC |
$1,480.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,045.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,106.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,027.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.08
|
| Rate for Payer: Multiplan Commercial |
$1,393.60
|
| Rate for Payer: Networks By Design Commercial |
$1,132.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,480.70
|
|
|
HC CL TREAT OF HEAD/NECK W/MANIPU
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
Hospital Revenue Code
|
456
|
| 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 HEAD/NECK W/MANIPU
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
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 HEAD/NECK W/MANIPU
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.28 |
| 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 Medi-Cal |
$439.28
|
| 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 HEAD/NECK W/MANIPU
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$439.28 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,217.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,509.19
|
| 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 |
$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 Medi-Cal |
$439.28
|
| 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: TriValley Medical Group Commercial/Senior |
$1,782.00
|
| 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 HUM SHAFT FRAC
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| 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 |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cigna of CA HMO |
$2,067.20
|
| Rate for Payer: Cigna of CA PPO |
$2,390.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| 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 |
$2,261.00
|
| 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 |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| 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 |
$2,051.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.20
|
| 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 |
$2,584.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,938.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,615.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,615.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,615.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| 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 HUM SHAFT FRAC
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,873.69
|
| 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 |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cigna of CA HMO |
$2,067.20
|
| Rate for Payer: Cigna of CA PPO |
$2,390.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| 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 |
$2,261.00
|
| 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 |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| 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 |
$2,051.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.20
|
| 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 |
$2,584.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,938.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,938.00
|
| 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 HUM SHAFT FRAC
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$2,745.50 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.00
|
| Rate for Payer: Galaxy Health WC |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,051.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,905.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.20
|
| Rate for Payer: Multiplan Commercial |
$2,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
|
|
HC CL TREAT OF HUM SHAFT FRAC
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$2,745.50 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.00
|
| Rate for Payer: Galaxy Health WC |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,051.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,905.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.20
|
| Rate for Payer: Multiplan Commercial |
$2,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
|
|
HC CL TREAT OF INTPHAL JOINT SIN
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
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 INTPHAL JOINT SIN
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$5,641.00 |
| 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 Medi-Cal |
$236.97
|
| 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
|
| Rate for Payer: Adventist Health Commercial |
$775.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,546.17
|
| 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 |
$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
|
|
|
HC CL TREAT OF INTPHAL JOINT SIN
|
Facility
|
IP
|
$1,891.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
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 INTPHAL JOINT SIN
|
Facility
|
OP
|
$1,891.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$5,641.00 |
| 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 |
$5,641.00
|
| 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 Medi-Cal |
$236.97
|
| 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 INTRPHAL JONT DISL
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
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 OF INTRPHAL JONT DISL
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$644.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$550.75
|
| 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 Medi-Cal |
$171.19
|
| 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 OF INTRPHAL JONT DISL
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
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 OF INTRPHAL JONT DISL
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.19 |
| 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 Medi-Cal |
$171.19
|
| 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 OF KNEE DISC W/ANESTH
|
Facility
|
IP
|
$3,813.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
900501087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$762.60 |
| Max. Negotiated Rate |
$3,241.05 |
| Rate for Payer: Adventist Health Commercial |
$762.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,933.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,932.20
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,669.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,525.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,525.20
|
| Rate for Payer: Galaxy Health WC |
$3,241.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,287.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,421.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,249.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.12
|
| Rate for Payer: Multiplan Commercial |
$3,050.40
|
| Rate for Payer: Networks By Design Commercial |
$2,478.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,241.05
|
|
|
HC CL TREAT OF KNEE DISC W/ANESTH
|
Facility
|
OP
|
$3,813.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
900501087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$762.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: Cash Price |
$1,715.85
|
| Rate for Payer: Cigna of CA HMO |
$2,440.32
|
| Rate for Payer: Cigna of CA PPO |
$2,821.62
|
| 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 |
$2,669.10
|
| 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 |
$3,241.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,287.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,421.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$915.12
|
| 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 |
$3,050.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,478.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,241.05
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,287.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,906.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,906.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,906.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,906.50
|
| 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 META FRAC SIN W/O
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$587.12 |
| Max. Negotiated Rate |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Cigna of CA HMO |
$3,457.92
|
| Rate for Payer: Cigna of CA PPO |
$3,998.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$587.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,701.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,701.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,701.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC CL TREAT OF META FRAC SIN W/O
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Cash Price |
$2,431.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,782.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,430.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,187.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
|
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$332.60 |
| Max. Negotiated Rate |
$1,413.55 |
| Rate for Payer: Adventist Health Commercial |
$332.60
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,164.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$665.20
|
| Rate for Payer: EPIC Health Plan Senior |
$665.20
|
| Rate for Payer: Galaxy Health WC |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,056.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$981.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| Rate for Payer: Multiplan Commercial |
$1,330.40
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
|
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.45 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$332.60
|
| 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 |
$748.35
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cash Price |
$748.35
|
| Rate for Payer: Cigna of CA HMO |
$1,064.32
|
| Rate for Payer: Cigna of CA PPO |
$1,230.62
|
| 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 |
$1,164.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,413.55
|
| Rate for Payer: Global Benefits Group Commercial |
$997.80
|
| 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 |
$1,056.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$263.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.12
|
| 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 |
$1,330.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,080.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,413.55
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$997.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$831.50
|
| Rate for Payer: United Healthcare All Other HMO |
$831.50
|
| Rate for Payer: United Healthcare HMO Rider |
$831.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$831.50
|
| 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
|
|
