|
HC CL TREAT OF PROX HUM FRAC W/MA
|
Facility
|
IP
|
$8,352.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
900501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,670.40 |
| Max. Negotiated Rate |
$7,516.80 |
| Rate for Payer: Adventist Health Commercial |
$1,670.40
|
| Rate for Payer: Cash Price |
$3,758.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,681.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,846.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,340.80
|
| Rate for Payer: Galaxy Health WC |
$7,099.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,011.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,516.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,303.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,927.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.40
|
| Rate for Payer: Multiplan Commercial |
$6,264.00
|
| Rate for Payer: Networks By Design Commercial |
$5,428.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,099.20
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,000.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$678.20 |
| Max. Negotiated Rate |
$3,051.90 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,000.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.75 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$678.20
|
| 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 |
$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 |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| 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 |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| 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 |
$2,882.35
|
| 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 |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,695.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,695.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,695.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,695.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$215.75 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,390.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$490.86
|
| 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 |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.80
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,373.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.90
|
| 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 |
$2,153.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$215.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,543.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| 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 |
$2,882.35
|
| 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 |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT OF RAD & ULN SHAFT FR
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,950.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
|
|
HC CL TREAT OF RAD & ULN SHAFT FR
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| 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 |
$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 |
$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 |
$3,240.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,200.00
|
| Rate for Payer: Cigna of CA PPO |
$3,700.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| 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 |
$3,175.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$505.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| 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 |
$4,250.00
|
| 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 |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,500.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,500.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,500.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,500.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CL TREAT OF SHLD DISLOC W/MANI
|
Facility
|
IP
|
$3,368.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$673.60 |
| Max. Negotiated Rate |
$3,031.20 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,694.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,347.20
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,031.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,987.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.60
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,862.80
|
|
|
HC CL TREAT OF SHLD DISLOC W/MANI
|
Facility
|
IP
|
$3,368.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$673.60 |
| Max. Negotiated Rate |
$3,031.20 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,694.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,347.20
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,031.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,987.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.60
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,862.80
|
|
|
HC CL TREAT OF SHLD DISLOC W/MANI
|
Facility
|
OP
|
$3,368.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.51 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$673.60
|
| 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 |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,694.40
|
| Rate for Payer: Cigna of CA HMO |
$2,155.52
|
| Rate for Payer: Cigna of CA PPO |
$2,492.32
|
| 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 |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,031.20
|
| 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 |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| 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 |
$2,862.80
|
| 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 |
$2,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,684.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,684.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,684.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,684.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT OF SHLD DISLOC W/MANI
|
Facility
|
OP
|
$3,368.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$266.51 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,380.88
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,516.99
|
| 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 |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,694.40
|
| Rate for Payer: Cigna of CA HMO |
$2,155.52
|
| Rate for Payer: Cigna of CA PPO |
$2,492.32
|
| 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 |
$2,357.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,862.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,031.20
|
| 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 |
$2,138.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$266.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,526.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,189.20
|
| 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 |
$2,862.80
|
| 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 |
$2,020.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,020.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT OF TIB SHFT FRAC W/WO
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
900501233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| 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 |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| 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 |
$1,449.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| 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 |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$351.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| 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 |
$1,759.50
|
| 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 |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT OF TIB SHFT FRAC W/WO
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
900501233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC CL TREAT OF TM DIS INT OR SUBQ
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$134.41 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$669.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$176.95
|
| 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 |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,307.20
|
| Rate for Payer: Cigna of CA HMO |
$1,045.76
|
| Rate for Payer: Cigna of CA PPO |
$1,209.16
|
| 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 |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,470.60
|
| 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 |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| 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 |
$1,388.90
|
| 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 |
$980.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$980.40
|
| 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 OF TM DIS INT OR SUBQ
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$1,470.60 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,307.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$653.60
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,470.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.80
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
|
|
HC CL TREAT OF TM DIS INT OR SUBQ
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$1,470.60 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,307.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$653.60
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,470.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.80
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
|
|
HC CL TREAT OF TM DIS INT OR SUBQ
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.41 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| 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 |
$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 |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,307.20
|
| Rate for Payer: Cigna of CA HMO |
$1,045.76
|
| Rate for Payer: Cigna of CA PPO |
$1,209.16
|
| 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 |
$1,143.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,470.60
|
| 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 |
$1,037.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,225.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| 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 |
$1,388.90
|
| 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 |
$980.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$817.00
|
| Rate for Payer: United Healthcare All Other HMO |
$817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$817.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$817.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT OF ULN SHAFT FRAC W/O
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Adventist Health Commercial |
$448.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,792.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,568.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.00
|
| Rate for Payer: EPIC Health Plan Senior |
$896.00
|
| Rate for Payer: Galaxy Health WC |
$1,904.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,016.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,422.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,321.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.00
|
| Rate for Payer: Multiplan Commercial |
$1,680.00
|
| Rate for Payer: Networks By Design Commercial |
$1,456.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.00
|
|
|
HC CL TREAT OF ULN SHAFT FRAC W/O
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.75 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$448.00
|
| 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 |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,792.00
|
| Rate for Payer: Cigna of CA HMO |
$1,433.60
|
| Rate for Payer: Cigna of CA PPO |
$1,657.60
|
| 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 |
$1,568.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,904.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,016.00
|
| 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 |
$1,422.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,680.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,456.00
|
| 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 |
$1,904.00
|
| 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 |
$1,344.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,120.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,120.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,120.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,120.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT OF WRIST DISLOCATION
|
Facility
|
IP
|
$1,888.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$377.60 |
| Max. Negotiated Rate |
$1,699.20 |
| Rate for Payer: Adventist Health Commercial |
$377.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,510.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$755.20
|
| Rate for Payer: EPIC Health Plan Senior |
$755.20
|
| Rate for Payer: Galaxy Health WC |
$1,604.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,699.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,198.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,113.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.60
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Networks By Design Commercial |
$1,227.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,604.80
|
|
|
HC CL TREAT OF WRIST DISLOCATION
|
Facility
|
OP
|
$1,888.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$377.60
|
| 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 |
$849.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Cash Price |
$849.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,510.40
|
| Rate for Payer: Cigna of CA HMO |
$1,208.32
|
| Rate for Payer: Cigna of CA PPO |
$1,397.12
|
| 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 |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,604.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,699.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,198.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$319.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,227.20
|
| 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 |
$1,604.80
|
| 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 |
$1,132.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$944.00
|
| Rate for Payer: United Healthcare All Other HMO |
$944.00
|
| Rate for Payer: United Healthcare HMO Rider |
$944.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$944.00
|
| 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 PHAL SHFT FX W/MANI
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,961.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC CL TREAT PHAL SHFT FX W/MANI
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,363.25
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,695.42
|
| 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 |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| 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 |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| 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 |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| 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 |
$2,826.25
|
| 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 |
$1,995.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,995.00
|
| 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 |
$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 PHAL SHFT FX W/MANI
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,961.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC CL TREAT PHAL SHFT FX W/MANI
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| 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 |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Cash Price |
$1,496.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| 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 |
$2,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| 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 |
$2,111.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| 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 |
$2,826.25
|
| 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 |
$1,995.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,662.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,662.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,662.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,662.50
|
| 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
|
|
