|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$462.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$560.34
|
| Rate for Payer: Blue Shield of California Commercial |
$782.28
|
| Rate for Payer: Blue Shield of California EPN |
$510.05
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: InnovAge PACE Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$379.80
|
| Rate for Payer: United Healthcare All Other HMO |
$369.68
|
| Rate for Payer: United Healthcare HMO Rider |
$361.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
OP
|
$3,326.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,334.91 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$1,829.30
|
| Rate for Payer: Cash Price |
$1,829.30
|
| Rate for Payer: Cash Price |
$1,829.30
|
| Rate for Payer: Cash Price |
$1,829.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: Cigna of CA HMO |
$2,128.64
|
| Rate for Payer: Cigna of CA PPO |
$2,461.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,663.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$2,993.40 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Cash Price |
$1,829.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.40
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Central Health Plan Commercial |
$853.60
|
| Rate for Payer: Cigna of CA HMO |
$682.88
|
| Rate for Payer: Cigna of CA PPO |
$789.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$960.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$533.50
|
| Rate for Payer: United Healthcare All Other HMO |
$533.50
|
| Rate for Payer: United Healthcare HMO Rider |
$533.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$533.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.40 |
| Max. Negotiated Rate |
$960.30 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Central Health Plan Commercial |
$853.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$426.80
|
| Rate for Payer: Galaxy Health WC |
$906.95
|
| Rate for Payer: Global Benefits Group Commercial |
$640.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$960.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$711.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$406.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$660.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.40
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
| Rate for Payer: Networks By Design Commercial |
$693.55
|
| Rate for Payer: Prime Health Services Commercial |
$906.95
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
|
IP
|
$13,630.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,267.00 |
| Rate for Payer: Adventist Health Commercial |
$2,726.00
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,904.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,452.00
|
| Rate for Payer: Galaxy Health WC |
$11,585.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,178.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,267.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,193.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,436.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,726.00
|
| Rate for Payer: Multiplan Commercial |
$10,222.50
|
| Rate for Payer: Networks By Design Commercial |
$8,859.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,585.50
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
|
OP
|
$13,630.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,032.26 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,726.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,496.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,222.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Central Health Plan Commercial |
$10,904.00
|
| Rate for Payer: Cigna of CA HMO |
$8,723.20
|
| Rate for Payer: Cigna of CA PPO |
$10,086.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,585.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,585.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,452.00
|
| Rate for Payer: Galaxy Health WC |
$11,585.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,178.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,267.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,032.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,815.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,091.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,140.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,436.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,726.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,541.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.00
|
| Rate for Payer: Multiplan Commercial |
$10,222.50
|
| Rate for Payer: Networks By Design Commercial |
$8,859.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,585.50
|
| Rate for Payer: Riverside University Health System MISP |
$5,452.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,178.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,178.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,585.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,585.50
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.30
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,584.00
|
| Rate for Payer: Cigna of CA HMO |
$2,067.20
|
| Rate for Payer: Cigna of CA PPO |
$2,390.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,907.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$2,422.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,938.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,938.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$2,907.00 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,584.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.00
|
| Rate for Payer: Galaxy Health WC |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,907.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,230.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,999.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.00
|
| Rate for Payer: Multiplan Commercial |
$2,422.50
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$2,907.00 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,584.00
|
| Rate for Payer: Cigna of CA HMO |
$2,067.20
|
| Rate for Payer: Cigna of CA PPO |
$2,390.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,907.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$2,422.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,938.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,615.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,615.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,615.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$3,230.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$2,907.00 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| Rate for Payer: Cash Price |
$1,776.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,584.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,292.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,292.00
|
| Rate for Payer: Galaxy Health WC |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,907.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,230.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,999.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$646.00
|
| Rate for Payer: Multiplan Commercial |
$2,422.50
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
OP
|
$2,476.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$495.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,361.80
|
| Rate for Payer: Cash Price |
$1,361.80
|
| Rate for Payer: Cash Price |
$1,361.80
|
| Rate for Payer: Cash Price |
$1,361.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,980.80
|
| Rate for Payer: Cigna of CA HMO |
$1,584.64
|
| Rate for Payer: Cigna of CA PPO |
$1,832.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$2,104.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,485.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,228.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,651.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,857.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,609.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.79
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,104.60
|
| Rate for Payer: Prime Health Services Medicare |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,238.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,238.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,238.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,238.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
IP
|
$2,476.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$495.20 |
| Max. Negotiated Rate |
$2,228.40 |
| Rate for Payer: Adventist Health Commercial |
$495.20
|
| Rate for Payer: Cash Price |
$1,361.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,980.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$990.40
|
| Rate for Payer: EPIC Health Plan Senior |
$990.40
|
| Rate for Payer: Galaxy Health WC |
$2,104.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,485.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,228.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,651.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$943.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,532.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.20
|
| Rate for Payer: Multiplan Commercial |
$1,857.00
|
| Rate for Payer: Networks By Design Commercial |
$1,609.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,104.60
|
|
|
HC CL TREAT ANKLE DISCLOC W/ANES
|
Facility
|
IP
|
$7,181.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,436.20 |
| Max. Negotiated Rate |
$6,462.90 |
| Rate for Payer: Adventist Health Commercial |
$1,436.20
|
| Rate for Payer: Cash Price |
$3,949.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,744.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,872.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,872.40
|
| Rate for Payer: Galaxy Health WC |
$6,103.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,308.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,462.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,735.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,445.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.20
|
| Rate for Payer: Multiplan Commercial |
$5,385.75
|
| Rate for Payer: Networks By Design Commercial |
$4,667.65
|
| Rate for Payer: Prime Health Services Commercial |
$6,103.85
|
|
|
HC CL TREAT ANKLE DISCLOC W/ANES
|
Facility
|
OP
|
$7,181.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.58 |
| Max. Negotiated Rate |
$6,462.90 |
| Rate for Payer: Adventist Health Commercial |
$1,436.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,949.55
|
| Rate for Payer: Cash Price |
$3,949.55
|
| Rate for Payer: Cash Price |
$3,949.55
|
| Rate for Payer: Cash Price |
$3,949.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,744.80
|
| Rate for Payer: Cigna of CA HMO |
$4,595.84
|
| Rate for Payer: Cigna of CA PPO |
$5,313.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$6,103.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,308.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,462.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,789.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$5,385.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,667.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$6,103.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,308.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,590.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,590.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,590.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,590.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT ANKLE MM FX W/O MANIP
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
900501371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| Rate for Payer: Cash Price |
$1,169.30
|
| 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 |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| 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 |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| 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 |
$304.79
|
| 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 |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| 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 |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT ANKLE MM FX W/O MANIP
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
900501371
|
|
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 |
$1,169.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.80
|
| 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 Permanente of CA Commercial/Self Funded |
$1,418.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$810.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,315.99
|
| 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 ARTICULAR FX,EA W/MAN
|
Facility
|
IP
|
$6,462.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
900501595
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,292.40 |
| Max. Negotiated Rate |
$5,815.80 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,169.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,584.80
|
| Rate for Payer: Galaxy Health WC |
$5,492.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,815.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,310.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,462.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| Rate for Payer: Networks By Design Commercial |
$4,200.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,492.70
|
|
|
HC CL TREAT ARTICULAR FX,EA W/MAN
|
Facility
|
OP
|
$6,462.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
900501595
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$2,649.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,169.60
|
| Rate for Payer: Cigna of CA HMO |
$4,135.68
|
| Rate for Payer: Cigna of CA PPO |
$4,781.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$5,492.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,815.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,310.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,200.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,492.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,877.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,877.20
|
| 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 |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT ARTICULAR FX,EA W/MAN
|
Facility
|
OP
|
$6,462.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
900501595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,169.60
|
| Rate for Payer: Cigna of CA HMO |
$4,135.68
|
| Rate for Payer: Cigna of CA PPO |
$4,781.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$5,492.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,815.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,310.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,200.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$5,492.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,231.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,231.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,231.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT ARTICULAR FX,EA W/MAN
|
Facility
|
IP
|
$6,462.00
|
|
|
Service Code
|
CPT 26742
|
| Hospital Charge Code |
900501595
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,292.40 |
| Max. Negotiated Rate |
$5,815.80 |
| Rate for Payer: Adventist Health Commercial |
$1,292.40
|
| Rate for Payer: Cash Price |
$3,554.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,169.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,584.80
|
| Rate for Payer: Galaxy Health WC |
$5,492.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,815.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,310.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,462.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,292.40
|
| Rate for Payer: Multiplan Commercial |
$4,846.50
|
| Rate for Payer: Networks By Design Commercial |
$4,200.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,492.70
|
|
|
HC CL TREAT ARTICULAR FX,EA W/O M
|
Facility
|
OP
|
$2,240.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
900501557
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| Rate for Payer: Cash Price |
$1,232.00
|
| 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 |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| 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 |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| 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 |
$304.79
|
| 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 |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| 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 |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT ARTICULAR FX,EA W/O M
|
Facility
|
IP
|
$2,240.00
|
|
|
Service Code
|
CPT 26740
|
| Hospital Charge Code |
900501557
|
|
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 |
$1,232.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,792.00
|
| 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 Permanente of CA Commercial/Self Funded |
$1,494.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,386.56
|
| 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 BIMALL ANKLE FX W/MAN
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
900501093
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$3,094.20 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,750.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,094.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.60
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: Networks By Design Commercial |
$2,234.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
|
|
HC CL TREAT BIMALL ANKLE FX W/MAN
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT 27810
|
| Hospital Charge Code |
900501093
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$3,094.20 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,750.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,094.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.60
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: Networks By Design Commercial |
$2,234.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
|
