|
HC CL TREAT ULNAR FX,PROXIMAL END
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
900501467
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| 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 |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| 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 |
$1,807.10
|
| 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 |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| 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 ULNAR FX, W/MANIPULAT
|
Facility
|
OP
|
$2,777.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$555.40
|
| 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 |
$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 |
$1,249.65
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,221.60
|
| Rate for Payer: Cigna of CA HMO |
$1,777.28
|
| Rate for Payer: Cigna of CA PPO |
$2,054.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,943.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$2,360.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,499.30
|
| 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 |
$1,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,082.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,805.05
|
| 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 |
$2,360.45
|
| 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 |
$1,666.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,388.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,388.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,388.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,388.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CL TREAT ULNAR FX, W/MANIPULAT
|
Facility
|
IP
|
$2,777.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$555.40 |
| Max. Negotiated Rate |
$2,499.30 |
| Rate for Payer: Adventist Health Commercial |
$555.40
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,221.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,943.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,110.80
|
| Rate for Payer: Galaxy Health WC |
$2,360.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,499.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,638.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.40
|
| Rate for Payer: Multiplan Commercial |
$2,082.75
|
| Rate for Payer: Networks By Design Commercial |
$1,805.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,360.45
|
|
|
HC CL TREAT ULNAR FX, W/MANIPULAT
|
Facility
|
IP
|
$2,777.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$555.40 |
| Max. Negotiated Rate |
$2,499.30 |
| Rate for Payer: Adventist Health Commercial |
$555.40
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,221.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,943.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,110.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,110.80
|
| Rate for Payer: Galaxy Health WC |
$2,360.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,499.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,638.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.40
|
| Rate for Payer: Multiplan Commercial |
$2,082.75
|
| Rate for Payer: Networks By Design Commercial |
$1,805.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,360.45
|
|
|
HC CL TREAT ULNAR FX, W/MANIPULAT
|
Facility
|
OP
|
$2,777.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.57
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,337.33
|
| 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 |
$1,249.65
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Cash Price |
$1,249.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,221.60
|
| Rate for Payer: Cigna of CA HMO |
$1,777.28
|
| Rate for Payer: Cigna of CA PPO |
$2,054.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,943.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$2,360.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,666.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,499.30
|
| 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 |
$1,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$455.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$555.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,082.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,805.05
|
| 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 |
$2,360.45
|
| 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 |
$1,666.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,666.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ULNAR SHAFT FX W/MANI
|
Facility
|
IP
|
$2,638.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$2,374.20 |
| Rate for Payer: Adventist Health Commercial |
$527.60
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,055.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,055.20
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,675.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,556.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,242.30
|
|
|
HC CL TREAT ULNAR SHAFT FX W/MANI
|
Facility
|
OP
|
$2,638.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$527.60
|
| 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 |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Cash Price |
$1,187.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,110.40
|
| Rate for Payer: Cigna of CA HMO |
$1,688.32
|
| Rate for Payer: Cigna of CA PPO |
$1,952.12
|
| 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 |
$1,846.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,242.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,374.20
|
| 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 |
$1,675.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$469.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$527.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,978.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,714.70
|
| 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 |
$2,242.30
|
| 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 |
$1,582.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,319.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,319.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,319.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,319.00
|
| 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 ULNAR STYLOID FX
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC CL TREAT ULNAR STYLOID FX
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| 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 |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$590.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| 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 |
$1,807.10
|
| 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 |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| 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 VERTEBRAL BODY FX W/O
|
Facility
|
IP
|
$2,259.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$451.80 |
| Max. Negotiated Rate |
$2,033.10 |
| Rate for Payer: Adventist Health Commercial |
$451.80
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,807.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,581.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$903.60
|
| Rate for Payer: EPIC Health Plan Senior |
$903.60
|
| Rate for Payer: Galaxy Health WC |
$1,920.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,355.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,033.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,434.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,332.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.80
|
| Rate for Payer: Multiplan Commercial |
$1,694.25
|
| Rate for Payer: Networks By Design Commercial |
$1,468.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,920.15
|
|
|
HC CL TREAT VERTEBRAL BODY FX W/O
|
Facility
|
OP
|
$2,259.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$451.80
|
| 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 |
$1,016.55
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,807.20
|
| Rate for Payer: Cigna of CA HMO |
$1,445.76
|
| Rate for Payer: Cigna of CA PPO |
$1,671.66
|
| 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 |
$1,581.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,920.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,355.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,033.10
|
| 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 |
$1,434.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,694.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,468.35
|
| 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 |
$1,920.15
|
| 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 |
$1,355.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,129.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,129.50
|
| 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 WRIST FX, W/MANIPULAT
|
Facility
|
OP
|
$1,695.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| 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 |
$762.75
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.00
|
| Rate for Payer: Cigna of CA HMO |
$1,084.80
|
| Rate for Payer: Cigna of CA PPO |
$1,254.30
|
| 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 |
$1,186.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,440.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,525.50
|
| 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 |
$1,076.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,101.75
|
| 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 |
$1,440.75
|
| 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 |
$1,017.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$847.50
|
| Rate for Payer: United Healthcare All Other HMO |
$847.50
|
| Rate for Payer: United Healthcare HMO Rider |
$847.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$847.50
|
| 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 WRIST FX, W/MANIPULAT
|
Facility
|
IP
|
$1,695.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.00 |
| Max. Negotiated Rate |
$1,525.50 |
| Rate for Payer: Adventist Health Commercial |
$339.00
|
| Rate for Payer: Cash Price |
$762.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,186.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.00
|
| Rate for Payer: EPIC Health Plan Senior |
$678.00
|
| Rate for Payer: Galaxy Health WC |
$1,440.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,017.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,525.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,076.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,000.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.00
|
| Rate for Payer: Multiplan Commercial |
$1,271.25
|
| Rate for Payer: Networks By Design Commercial |
$1,101.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,440.75
|
|
|
HC CL TRT FEM FX W/O MANIP PE NCK
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.20 |
| Max. Negotiated Rate |
$1,913.40 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.40
|
| Rate for Payer: EPIC Health Plan Senior |
$850.40
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,254.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,807.10
|
|
|
HC CL TRT FEM FX W/O MANIP PE NCK
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$425.20
|
| 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 |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Cash Price |
$956.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| Rate for Payer: Cigna of CA HMO |
$1,360.64
|
| Rate for Payer: Cigna of CA PPO |
$1,573.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,488.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,807.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,913.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,594.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,381.90
|
| 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 |
$1,807.10
|
| 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 |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,063.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,063.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,063.00
|
| 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 TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,182.60 |
| Rate for Payer: Adventist Health Commercial |
$262.80
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,051.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$919.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$525.60
|
| Rate for Payer: EPIC Health Plan Senior |
$525.60
|
| Rate for Payer: Galaxy Health WC |
$1,116.90
|
| Rate for Payer: Global Benefits Group Commercial |
$788.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,182.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$834.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$775.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$985.50
|
| Rate for Payer: Networks By Design Commercial |
$854.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,116.90
|
|
|
HC CL TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$262.80
|
| 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 |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,051.20
|
| Rate for Payer: Cigna of CA HMO |
$840.96
|
| Rate for Payer: Cigna of CA PPO |
$972.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$919.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,116.90
|
| Rate for Payer: Global Benefits Group Commercial |
$788.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,182.60
|
| 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 |
$834.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$985.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$854.10
|
| 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 |
$1,116.90
|
| 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 |
$788.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$657.00
|
| Rate for Payer: United Healthcare All Other HMO |
$657.00
|
| Rate for Payer: United Healthcare HMO Rider |
$657.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$657.00
|
| 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 TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$3,865.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.27 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$773.00
|
| 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 |
$1,739.25
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,092.00
|
| Rate for Payer: Cigna of CA HMO |
$2,473.60
|
| Rate for Payer: Cigna of CA PPO |
$2,860.10
|
| 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 |
$2,705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$3,285.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,319.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,478.50
|
| 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 |
$2,454.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,898.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,512.25
|
| 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 |
$3,285.25
|
| 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 |
$2,319.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,932.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,932.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,932.50
|
| 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 TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$3,865.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$294.27 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,584.65
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,314.02
|
| 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 |
$1,739.25
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,092.00
|
| Rate for Payer: Cigna of CA HMO |
$2,473.60
|
| Rate for Payer: Cigna of CA PPO |
$2,860.10
|
| 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 |
$2,705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$3,285.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,319.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,478.50
|
| 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 |
$2,454.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,898.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,512.25
|
| 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 |
$3,285.25
|
| 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 |
$2,319.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,319.00
|
| 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 TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$3,865.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$773.00 |
| Max. Negotiated Rate |
$3,478.50 |
| Rate for Payer: Adventist Health Commercial |
$773.00
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,092.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,546.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,546.00
|
| Rate for Payer: Galaxy Health WC |
$3,285.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,319.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,478.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,454.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,280.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.75
|
| Rate for Payer: Networks By Design Commercial |
$2,512.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,285.25
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$3,865.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$773.00 |
| Max. Negotiated Rate |
$3,478.50 |
| Rate for Payer: Adventist Health Commercial |
$773.00
|
| Rate for Payer: Cash Price |
$1,739.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,092.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,705.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,546.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,546.00
|
| Rate for Payer: Galaxy Health WC |
$3,285.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,319.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,478.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,454.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,280.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$773.00
|
| Rate for Payer: Multiplan Commercial |
$2,898.75
|
| Rate for Payer: Networks By Design Commercial |
$2,512.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,285.25
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
OP
|
$2,548.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| 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 |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Cigna of CA HMO |
$1,630.72
|
| Rate for Payer: Cigna of CA PPO |
$1,885.52
|
| 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 |
$1,783.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| 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 |
$1,617.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| 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 |
$2,165.80
|
| 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 |
$1,528.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,274.00
|
| 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 TRT OF KNEE DISC W/O ANESTH
|
Facility
|
IP
|
$2,548.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$2,293.20 |
| Rate for Payer: Adventist Health Commercial |
$509.60
|
| Rate for Payer: Cash Price |
$1,146.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,038.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,783.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,019.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,019.20
|
| Rate for Payer: Galaxy Health WC |
$2,165.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,528.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,293.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,617.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,503.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$1,911.00
|
| Rate for Payer: Networks By Design Commercial |
$1,656.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,165.80
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
905353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.77 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.17
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
915353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$80.20
|
| Rate for Payer: Blue Shield of California EPN |
$50.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
