|
HC CLOSE CARDINAL MYNXGRIP 6F/7F
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
906812637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Blue Shield of California Commercial |
$756.29
|
| Rate for Payer: Blue Shield of California EPN |
$475.27
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: Cigna of CA HMO |
$660.10
|
| Rate for Payer: Cigna of CA PPO |
$660.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Networks By Design Commercial |
$471.50
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$353.91
|
| Rate for Payer: United Healthcare All Other HMO |
$344.48
|
| Rate for Payer: United Healthcare HMO Rider |
$337.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$308.83
|
|
|
HC CLOSE CARDINAL MYNXGRIP 6F/7F
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
906812637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$430.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$517.14
|
| Rate for Payer: Blue Shield of California Commercial |
$756.29
|
| Rate for Payer: Blue Shield of California EPN |
$475.27
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: Cigna of CA HMO |
$660.10
|
| Rate for Payer: Cigna of CA PPO |
$660.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$801.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$801.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$801.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$660.10
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Networks By Design Commercial |
$471.50
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Riverside University Health System MISP |
$377.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$353.91
|
| Rate for Payer: United Healthcare All Other HMO |
$344.48
|
| Rate for Payer: United Healthcare HMO Rider |
$337.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$308.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$801.55
|
| Rate for Payer: Vantage Medical Group Senior |
$801.55
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
OP
|
$5,352.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,070.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$2,408.40
|
| Rate for Payer: Cash Price |
$2,408.40
|
| Rate for Payer: Cash Price |
$2,408.40
|
| Rate for Payer: Cash Price |
$2,408.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,281.60
|
| Rate for Payer: Cigna of CA HMO |
$3,425.28
|
| Rate for Payer: Cigna of CA PPO |
$3,960.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,746.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$4,549.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,816.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,398.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$497.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$4,014.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$3,478.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$4,549.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,115.34
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,195.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,211.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,676.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,676.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
IP
|
$5,352.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,070.40 |
| Max. Negotiated Rate |
$4,816.80 |
| Rate for Payer: Adventist Health Commercial |
$1,070.40
|
| Rate for Payer: Cash Price |
$2,408.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,281.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,746.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,140.80
|
| Rate for Payer: Galaxy Health WC |
$4,549.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,211.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,816.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,398.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,157.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Multiplan Commercial |
$4,014.00
|
| Rate for Payer: Networks By Design Commercial |
$3,478.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,549.20
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.60 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Cigna of CA HMO |
$705.92
|
| Rate for Payer: Cigna of CA PPO |
$816.22
|
| 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 |
$772.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| 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 |
$700.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$716.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$551.50
|
| Rate for Payer: United Healthcare All Other HMO |
$551.50
|
| Rate for Payer: United Healthcare HMO Rider |
$551.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.50
|
| 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 CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$220.60 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Cash Price |
$496.35
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$772.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$700.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$650.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.60
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Networks By Design Commercial |
$716.95
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,400.00 |
| Max. Negotiated Rate |
$6,300.00 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,600.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,800.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,800.00
|
| Rate for Payer: Galaxy Health WC |
$5,950.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,200.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,300.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,445.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,130.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.00
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
| Rate for Payer: Networks By Design Commercial |
$4,550.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,950.00
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,943.76 |
| Rate for Payer: Adventist Health Commercial |
$1,400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Cash Price |
$3,150.00
|
| Rate for Payer: Central Health Plan Commercial |
$5,600.00
|
| Rate for Payer: Cigna of CA HMO |
$4,480.00
|
| Rate for Payer: Cigna of CA PPO |
$5,180.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$5,950.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,200.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,300.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,445.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$756.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,400.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$5,250.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$4,550.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$5,950.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,200.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,500.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
OP
|
$1,295.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: Cigna of CA HMO |
$828.80
|
| Rate for Payer: Cigna of CA PPO |
$958.30
|
| 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 |
$906.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| 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 |
$822.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$307.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$647.50
|
| Rate for Payer: United Healthcare All Other HMO |
$647.50
|
| Rate for Payer: United Healthcare HMO Rider |
$647.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$647.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
IP
|
$1,295.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$259.00 |
| Max. Negotiated Rate |
$1,165.50 |
| Rate for Payer: Adventist Health Commercial |
$259.00
|
| Rate for Payer: Cash Price |
$582.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,036.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$906.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.00
|
| Rate for Payer: EPIC Health Plan Senior |
$518.00
|
| Rate for Payer: Galaxy Health WC |
$1,100.75
|
| Rate for Payer: Global Benefits Group Commercial |
$777.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,165.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$822.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$764.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$971.25
|
| Rate for Payer: Networks By Design Commercial |
$841.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,100.75
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
OP
|
$2,167.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.94 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$433.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,733.60
|
| Rate for Payer: Cigna of CA HMO |
$1,386.88
|
| Rate for Payer: Cigna of CA PPO |
$1,603.58
|
| 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 |
$1,516.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,841.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,300.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,950.30
|
| 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 |
$1,376.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$224.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,625.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,408.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,841.95
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,300.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,083.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,083.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,083.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,083.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
IP
|
$2,167.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$433.40 |
| Max. Negotiated Rate |
$1,950.30 |
| Rate for Payer: Adventist Health Commercial |
$433.40
|
| Rate for Payer: Cash Price |
$975.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,733.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,516.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$866.80
|
| Rate for Payer: EPIC Health Plan Senior |
$866.80
|
| Rate for Payer: Galaxy Health WC |
$1,841.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,300.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,950.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,376.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,278.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$433.40
|
| Rate for Payer: Multiplan Commercial |
$1,625.25
|
| Rate for Payer: Networks By Design Commercial |
$1,408.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,841.95
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
OP
|
$3,014.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$602.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,411.20
|
| Rate for Payer: Cigna of CA HMO |
$1,928.96
|
| Rate for Payer: Cigna of CA PPO |
$2,230.36
|
| 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 |
$2,109.80
|
| 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 |
$2,561.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,808.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,712.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,913.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,260.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,959.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,561.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,808.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,507.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,507.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,507.00
|
| 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 CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
IP
|
$3,014.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.80 |
| Max. Negotiated Rate |
$2,712.60 |
| Rate for Payer: Adventist Health Commercial |
$602.80
|
| Rate for Payer: Cash Price |
$1,356.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,411.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,109.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,205.60
|
| Rate for Payer: Galaxy Health WC |
$2,561.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,808.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,712.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,913.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,778.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.80
|
| Rate for Payer: Multiplan Commercial |
$2,260.50
|
| Rate for Payer: Networks By Design Commercial |
$1,959.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,561.90
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Adventist Health Commercial |
$16.60
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Blue Shield of California Commercial |
$60.48
|
| Rate for Payer: Blue Shield of California Commercial |
$52.29
|
| Rate for Payer: Blue Shield of California EPN |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$32.95
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Central Health Plan Commercial |
$66.40
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$53.12
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Cigna of CA PPO |
$61.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$70.55
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$49.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$62.25
|
| Rate for Payer: Networks By Design Commercial |
$53.95
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Prime Health Services Commercial |
$70.55
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Adventist Health Commercial |
$16.60
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Blue Shield of California Commercial |
$60.48
|
| Rate for Payer: Blue Shield of California Commercial |
$52.29
|
| Rate for Payer: Blue Shield of California EPN |
$38.11
|
| Rate for Payer: Blue Shield of California EPN |
$32.95
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Central Health Plan Commercial |
$66.40
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$53.12
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Cigna of CA PPO |
$61.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.77
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: EPIC Health Plan Senior |
$13.18
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$70.55
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Global Benefits Group Commercial |
$49.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$62.25
|
| Rate for Payer: Networks By Design Commercial |
$53.95
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.98
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Prime Health Services Commercial |
$70.55
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Blue Shield of California Commercial |
$811.62
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$462.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$554.98
|
| Rate for Payer: Blue Shield of California Commercial |
$811.62
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
OP
|
$3,326.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: Cigna of CA HMO |
$2,128.64
|
| Rate for Payer: Cigna of CA PPO |
$2,461.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,328.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| 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 |
$2,112.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,192.24
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,274.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,663.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$2,993.40 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,328.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.40
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,112.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,962.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$960.30 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Central Health Plan Commercial |
$853.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$746.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$960.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$677.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$629.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.40
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Cash Price |
$480.15
|
| Rate for Payer: Central Health Plan Commercial |
$853.60
|
| Rate for Payer: Cigna of CA HMO |
$682.88
|
| Rate for Payer: Cigna of CA PPO |
$789.58
|
| 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 |
$746.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$960.30
|
| 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 |
$677.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.50
|
| Rate for Payer: United Healthcare All Other HMO |
$533.50
|
| Rate for Payer: United Healthcare HMO Rider |
$533.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$533.50
|
| 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 CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
|
OP
|
$13,630.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,032.26 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,726.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,496.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,222.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$6,133.50
|
| Rate for Payer: Cash Price |
$6,133.50
|
| Rate for Payer: Cash Price |
$6,133.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,904.00
|
| Rate for Payer: Cigna of CA HMO |
$8,723.20
|
| Rate for Payer: Cigna of CA PPO |
$10,086.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,585.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,585.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,541.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,452.00
|
| Rate for Payer: Galaxy Health WC |
$11,585.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,178.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,267.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,032.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,655.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,140.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,041.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,726.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,541.00
|
| Rate for Payer: Multiplan Commercial |
$10,222.50
|
| Rate for Payer: Networks By Design Commercial |
$8,859.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,585.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,452.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,178.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,178.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,815.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,585.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,585.50
|
|
