|
HC CL TREAT RADIAL SHAFT FRX W/DI
|
Facility
|
IP
|
$2,027.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$405.40 |
| Max. Negotiated Rate |
$1,722.95 |
| Rate for Payer: Adventist Health Commercial |
$405.40
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,418.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.80
|
| Rate for Payer: EPIC Health Plan Senior |
$810.80
|
| Rate for Payer: Galaxy Health WC |
$1,722.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,216.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,287.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,195.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.48
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: Networks By Design Commercial |
$1,317.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.95
|
|
|
HC CL TREAT RADIAL SHAFT FRX W/DI
|
Facility
|
OP
|
$2,027.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.08 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$405.40
|
| 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 |
$912.15
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Cash Price |
$912.15
|
| Rate for Payer: Cigna of CA HMO |
$1,297.28
|
| Rate for Payer: Cigna of CA PPO |
$1,499.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,418.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$1,722.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,216.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,287.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,621.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,317.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,722.95
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,216.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,013.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,013.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,013.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,013.50
|
| 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 RADIAL SHAFT FX W/O M
|
Facility
|
IP
|
$1,964.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$1,669.40 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.60
|
| Rate for Payer: EPIC Health Plan Senior |
$785.60
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,158.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.36
|
| Rate for Payer: Multiplan Commercial |
$1,571.20
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
|
|
HC CL TREAT RADIAL SHAFT FX W/O M
|
Facility
|
OP
|
$1,964.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.31 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| 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 |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Cigna of CA HMO |
$1,256.96
|
| Rate for Payer: Cigna of CA PPO |
$1,453.36
|
| 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 |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$281.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,571.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,178.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$982.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$982.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$982.00
|
| 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 RADIOULNAR DIS W/MANI
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$335.20
|
| 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 |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna of CA HMO |
$1,072.64
|
| Rate for Payer: Cigna of CA PPO |
$1,240.24
|
| 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 |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| 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 |
$1,064.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$436.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$838.00
|
| Rate for Payer: United Healthcare All Other HMO |
$838.00
|
| Rate for Payer: United Healthcare HMO Rider |
$838.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$838.00
|
| 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 RADIOULNAR DIS W/MANI
|
Facility
|
OP
|
$1,676.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Adventist Health Commercial |
$687.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,495.91
|
| 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 |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Cigna of CA HMO |
$1,072.64
|
| Rate for Payer: Cigna of CA PPO |
$1,240.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| 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 |
$1,064.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$436.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.60
|
| 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 RADIOULNAR DIS W/MANI
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$335.20 |
| Max. Negotiated Rate |
$1,424.60 |
| Rate for Payer: Adventist Health Commercial |
$335.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.40
|
| Rate for Payer: EPIC Health Plan Senior |
$670.40
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,064.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$988.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
|
|
HC CL TREAT RADIOULNAR DIS W/MANI
|
Facility
|
IP
|
$1,676.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.20 |
| Max. Negotiated Rate |
$1,424.60 |
| Rate for Payer: Adventist Health Commercial |
$335.20
|
| Rate for Payer: Cash Price |
$754.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.40
|
| Rate for Payer: EPIC Health Plan Senior |
$670.40
|
| Rate for Payer: Galaxy Health WC |
$1,424.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,064.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$988.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.24
|
| Rate for Payer: Multiplan Commercial |
$1,340.80
|
| Rate for Payer: Networks By Design Commercial |
$1,089.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,424.60
|
|
|
HC CL TREAT RADIUS/ULNA FX,W/O MA
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
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 RADIUS/ULNA FX,W/O MA
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$6,716.00 |
| 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 |
$6,716.00
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$943.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other HMO |
$786.00
|
| Rate for Payer: United Healthcare HMO Rider |
$786.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT RAD SHAFT FRX W/MANIP
|
Facility
|
IP
|
$2,735.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$547.00 |
| Max. Negotiated Rate |
$2,324.75 |
| Rate for Payer: Adventist Health Commercial |
$547.00
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,914.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,094.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,094.00
|
| Rate for Payer: Galaxy Health WC |
$2,324.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,736.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,613.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.40
|
| Rate for Payer: Multiplan Commercial |
$2,188.00
|
| Rate for Payer: Networks By Design Commercial |
$1,777.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,324.75
|
|
|
HC CL TREAT RAD SHAFT FRX W/MANIP
|
Facility
|
OP
|
$2,735.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$478.17 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$547.00
|
| 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 |
$1,230.75
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: Cigna of CA HMO |
$1,750.40
|
| Rate for Payer: Cigna of CA PPO |
$2,023.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,914.50
|
| 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 |
$2,324.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.00
|
| 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 |
$1,736.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$478.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.40
|
| 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 |
$2,188.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,777.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,324.75
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,641.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.50
|
| 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 SCAPULAR FX, W/O MANI
|
Facility
|
IP
|
$1,674.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$334.80 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Adventist Health Commercial |
$334.80
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,171.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.60
|
| Rate for Payer: EPIC Health Plan Senior |
$669.60
|
| Rate for Payer: Galaxy Health WC |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,062.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$987.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.76
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
|
|
HC CL TREAT SCAPULAR FX, W/O MANI
|
Facility
|
OP
|
$1,674.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$334.80
|
| 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 |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna of CA HMO |
$1,071.36
|
| Rate for Payer: Cigna of CA PPO |
$1,238.76
|
| 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 |
$1,171.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,062.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.76
|
| 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 |
$1,339.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,004.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$837.00
|
| Rate for Payer: United Healthcare All Other HMO |
$837.00
|
| Rate for Payer: United Healthcare HMO Rider |
$837.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$837.00
|
| 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 SCAPULAR FX, W/O MANI
|
Facility
|
OP
|
$1,674.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$686.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,494.24
|
| 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 |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna of CA HMO |
$1,071.36
|
| Rate for Payer: Cigna of CA PPO |
$1,238.76
|
| 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 |
$1,171.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,062.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.76
|
| 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 |
$1,339.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,004.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,004.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT SCAPULAR FX, W/O MANI
|
Facility
|
IP
|
$1,674.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$334.80 |
| Max. Negotiated Rate |
$1,422.90 |
| Rate for Payer: Adventist Health Commercial |
$334.80
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,171.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$669.60
|
| Rate for Payer: EPIC Health Plan Senior |
$669.60
|
| Rate for Payer: Galaxy Health WC |
$1,422.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,004.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,062.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$987.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.76
|
| Rate for Payer: Multiplan Commercial |
$1,339.20
|
| Rate for Payer: Networks By Design Commercial |
$1,088.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,422.90
|
|
|
HC CL TREAT SC/TC HMRL FX W/MANIP
|
Facility
|
IP
|
$3,714.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.80 |
| Max. Negotiated Rate |
$3,156.90 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,599.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,485.60
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,358.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| Rate for Payer: Multiplan Commercial |
$2,971.20
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
|
|
HC CL TREAT SC/TC HMRL FX W/MANIP
|
Facility
|
OP
|
$3,714.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,522.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,616.95
|
| 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 |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cigna of CA HMO |
$2,376.96
|
| Rate for Payer: Cigna of CA PPO |
$2,748.36
|
| 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 |
$2,599.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| 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 |
$2,358.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| 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 |
$2,971.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,228.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,228.40
|
| 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 SC/TC HMRL FX W/MANIP
|
Facility
|
OP
|
$3,714.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$742.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Cigna of CA HMO |
$2,376.96
|
| Rate for Payer: Cigna of CA PPO |
$2,748.36
|
| 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 |
$2,599.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| 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 |
$2,358.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| 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 |
$2,971.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,228.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,857.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,857.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,857.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,857.00
|
| 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 SC/TC HMRL FX W/MANIP
|
Facility
|
IP
|
$3,714.00
|
|
|
Service Code
|
CPT 24535
|
| Hospital Charge Code |
900501229
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$742.80 |
| Max. Negotiated Rate |
$3,156.90 |
| Rate for Payer: Adventist Health Commercial |
$742.80
|
| Rate for Payer: Cash Price |
$1,671.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,599.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,485.60
|
| Rate for Payer: Galaxy Health WC |
$3,156.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,228.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,358.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$891.36
|
| Rate for Payer: Multiplan Commercial |
$2,971.20
|
| Rate for Payer: Networks By Design Commercial |
$2,414.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,156.90
|
|
|
HC CL TREAT SHLDR DISLOC W/ANES
|
Facility
|
IP
|
$6,365.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,273.00 |
| Max. Negotiated Rate |
$5,410.25 |
| Rate for Payer: Adventist Health Commercial |
$1,273.00
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,455.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,546.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,546.00
|
| Rate for Payer: Galaxy Health WC |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,041.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,755.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
|
|
HC CL TREAT SHLDR DISLOC W/ANES
|
Facility
|
OP
|
$6,365.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$2,609.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,484.92
|
| 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 |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cigna of CA HMO |
$4,073.60
|
| Rate for Payer: Cigna of CA PPO |
$4,710.10
|
| 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 |
$4,455.50
|
| 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 |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| 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 |
$4,041.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| 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 |
$5,092.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,819.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,819.00
|
| 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 SHLDR DISLOC W/ANES
|
Facility
|
IP
|
$6,365.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,273.00 |
| Max. Negotiated Rate |
$5,410.25 |
| Rate for Payer: Adventist Health Commercial |
$1,273.00
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,455.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,546.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,546.00
|
| Rate for Payer: Galaxy Health WC |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,041.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,755.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| Rate for Payer: Multiplan Commercial |
$5,092.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
|
|
HC CL TREAT SHLDR DISLOC W/ANES
|
Facility
|
OP
|
$6,365.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
900501061
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,273.00
|
| 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 |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cash Price |
$2,864.25
|
| Rate for Payer: Cigna of CA HMO |
$4,073.60
|
| Rate for Payer: Cigna of CA PPO |
$4,710.10
|
| 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 |
$4,455.50
|
| 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 |
$5,410.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,819.00
|
| 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 |
$4,041.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,527.60
|
| 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 |
$5,092.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,137.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,410.25
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,819.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,182.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,182.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,182.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,182.50
|
| 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 SHLDR DISLO/FX W/MANI
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
900501501
|
|
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
|
|
