|
HC CL TREAT OF HUM SHAFT FRAC
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$4,523.40 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,010.40
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,523.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,352.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,111.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.20
|
| Rate for Payer: Multiplan Commercial |
$3,769.50
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
|
|
HC CL TREAT OF HUM SHAFT FRAC
|
Facility
|
IP
|
$5,026.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,005.20 |
| Max. Negotiated Rate |
$4,523.40 |
| Rate for Payer: Adventist Health Commercial |
$1,005.20
|
| Rate for Payer: Cash Price |
$2,764.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,020.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,010.40
|
| Rate for Payer: Galaxy Health WC |
$4,272.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,523.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,352.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,111.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,005.20
|
| Rate for Payer: Multiplan Commercial |
$3,769.50
|
| Rate for Payer: Networks By Design Commercial |
$3,266.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,272.10
|
|
|
HC CL TREAT OF INTPHAL JOINT SIN
|
Facility
|
IP
|
$2,943.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$588.60 |
| Max. Negotiated Rate |
$2,648.70 |
| Rate for Payer: Adventist Health Commercial |
$588.60
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,177.20
|
| Rate for Payer: Galaxy Health WC |
$2,501.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,648.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,962.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,821.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.60
|
| Rate for Payer: Multiplan Commercial |
$2,207.25
|
| Rate for Payer: Networks By Design Commercial |
$1,912.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,501.55
|
|
|
HC CL TREAT OF INTPHAL JOINT SIN
|
Facility
|
IP
|
$2,943.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.60 |
| Max. Negotiated Rate |
$2,648.70 |
| Rate for Payer: Adventist Health Commercial |
$588.60
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,177.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,177.20
|
| Rate for Payer: Galaxy Health WC |
$2,501.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,648.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,962.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,821.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.60
|
| Rate for Payer: Multiplan Commercial |
$2,207.25
|
| Rate for Payer: Networks By Design Commercial |
$1,912.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,501.55
|
|
|
HC CL TREAT OF INTPHAL JOINT SIN
|
Facility
|
OP
|
$2,943.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$588.60
|
| 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 |
$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 |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,354.40
|
| Rate for Payer: Cigna of CA HMO |
$1,883.52
|
| Rate for Payer: Cigna of CA PPO |
$2,177.82
|
| 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 |
$2,501.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,648.70
|
| 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 |
$1,962.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.60
|
| 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 |
$2,207.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,912.95
|
| 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 |
$2,501.55
|
| 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 |
$1,765.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,471.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,471.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,471.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,471.50
|
| 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 CL TREAT OF INTPHAL JOINT SIN
|
Facility
|
OP
|
$2,943.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$2,648.70 |
| Rate for Payer: Adventist Health Commercial |
$1,206.63
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,787.28
|
| 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 |
$1,728.42
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Cash Price |
$1,618.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,354.40
|
| Rate for Payer: Cigna of CA HMO |
$1,883.52
|
| Rate for Payer: Cigna of CA PPO |
$2,177.82
|
| 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 |
$2,501.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,648.70
|
| 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 |
$1,962.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.60
|
| 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 |
$2,207.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,912.95
|
| 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 |
$2,501.55
|
| 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 |
$1,765.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,765.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 OF INTRPHAL JONT DISL
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$171.19 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$871.66
|
| 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 |
$1,248.60
|
| 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 Medi-Cal |
$171.19
|
| 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: TriValley Medical Group Commercial/Senior |
$1,275.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 OF INTRPHAL JONT DISL
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
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 OF INTRPHAL JONT DISL
|
Facility
|
OP
|
$2,126.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.19 |
| 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 Medi-Cal |
$171.19
|
| 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 OF INTRPHAL JONT DISL
|
Facility
|
IP
|
$2,126.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
Hospital Revenue Code
|
456
|
| 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 OF KNEE DISC W/ANESTH
|
Facility
|
IP
|
$7,181.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
900501087
|
|
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 OF KNEE DISC W/ANESTH
|
Facility
|
OP
|
$7,181.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
900501087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| 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 |
$499.40
|
| 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 OF META FRAC SIN W/O
|
Facility
|
IP
|
$8,405.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,681.00 |
| Max. Negotiated Rate |
$7,564.50 |
| Rate for Payer: Adventist Health Commercial |
$1,681.00
|
| Rate for Payer: Cash Price |
$4,622.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,724.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,362.00
|
| Rate for Payer: Galaxy Health WC |
$7,144.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,043.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,564.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,202.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,202.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.00
|
| Rate for Payer: Multiplan Commercial |
$6,303.75
|
| Rate for Payer: Networks By Design Commercial |
$5,463.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,144.25
|
|
|
HC CL TREAT OF META FRAC SIN W/O
|
Facility
|
OP
|
$8,405.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,681.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$4,622.75
|
| Rate for Payer: Cash Price |
$4,622.75
|
| Rate for Payer: Cash Price |
$4,622.75
|
| Rate for Payer: Cash Price |
$4,622.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,724.00
|
| Rate for Payer: Cigna of CA HMO |
$5,379.20
|
| Rate for Payer: Cigna of CA PPO |
$6,219.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$7,144.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,043.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,564.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$6,303.75
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$5,463.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$7,144.25
|
| Rate for Payer: Prime Health Services Medicare |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,043.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,202.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
|
OP
|
$2,586.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.45 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$517.20
|
| 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 |
$1,422.30
|
| Rate for Payer: Cash Price |
$1,422.30
|
| Rate for Payer: Cash Price |
$1,422.30
|
| Rate for Payer: Cash Price |
$1,422.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,068.80
|
| Rate for Payer: Cigna of CA HMO |
$1,655.04
|
| Rate for Payer: Cigna of CA PPO |
$1,913.64
|
| 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 |
$2,198.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,551.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,327.40
|
| 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 |
$1,724.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$263.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.20
|
| 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 |
$1,939.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,680.90
|
| 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 |
$2,198.10
|
| 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 |
$1,551.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,293.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,293.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,293.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,293.00
|
| 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 OF MET FRAC W/O MANIP
|
Facility
|
IP
|
$2,586.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$2,327.40 |
| Rate for Payer: Adventist Health Commercial |
$517.20
|
| Rate for Payer: Cash Price |
$1,422.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,068.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,034.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,034.40
|
| Rate for Payer: Galaxy Health WC |
$2,198.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,551.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,327.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,724.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$985.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,600.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$517.20
|
| Rate for Payer: Multiplan Commercial |
$1,939.50
|
| Rate for Payer: Networks By Design Commercial |
$1,680.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,198.10
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
OP
|
$7,258.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$6,532.20 |
| Rate for Payer: Adventist Health Commercial |
$2,975.78
|
| 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 |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| 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 |
$2,998.82
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,806.40
|
| Rate for Payer: Cigna of CA HMO |
$4,645.12
|
| Rate for Payer: Cigna of CA PPO |
$5,370.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$6,169.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,354.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,532.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,841.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$5,443.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$4,717.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,169.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,354.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,354.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
IP
|
$7,258.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,451.60 |
| Max. Negotiated Rate |
$6,532.20 |
| Rate for Payer: Adventist Health Commercial |
$1,451.60
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,903.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,903.20
|
| Rate for Payer: Galaxy Health WC |
$6,169.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,354.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,532.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,841.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,765.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,492.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.60
|
| Rate for Payer: Multiplan Commercial |
$5,443.50
|
| Rate for Payer: Networks By Design Commercial |
$4,717.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,169.30
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
OP
|
$7,258.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$150.67 |
| Max. Negotiated Rate |
$6,532.20 |
| Rate for Payer: Adventist Health Commercial |
$1,451.60
|
| 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 |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| 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 |
$2,998.82
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,806.40
|
| Rate for Payer: Cigna of CA HMO |
$4,645.12
|
| Rate for Payer: Cigna of CA PPO |
$5,370.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$6,169.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,354.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,532.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,841.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$5,443.50
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$4,717.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,169.30
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,354.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,629.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,629.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,629.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,629.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
IP
|
$7,258.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,451.60 |
| Max. Negotiated Rate |
$6,532.20 |
| Rate for Payer: Adventist Health Commercial |
$1,451.60
|
| Rate for Payer: Cash Price |
$3,991.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,806.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,903.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,903.20
|
| Rate for Payer: Galaxy Health WC |
$6,169.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,354.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,532.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,841.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,765.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,492.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,451.60
|
| Rate for Payer: Multiplan Commercial |
$5,443.50
|
| Rate for Payer: Networks By Design Commercial |
$4,717.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,169.30
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
|
OP
|
$8,587.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$7,728.30 |
| Rate for Payer: Adventist Health Commercial |
$1,717.40
|
| 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 |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| 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 |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,722.85
|
| Rate for Payer: Cash Price |
$4,722.85
|
| Rate for Payer: Cash Price |
$4,722.85
|
| Rate for Payer: Cash Price |
$4,722.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,869.60
|
| Rate for Payer: Cigna of CA HMO |
$5,495.68
|
| Rate for Payer: Cigna of CA PPO |
$6,354.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$7,298.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,152.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,728.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,727.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$240.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$6,440.25
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$5,581.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,298.95
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,152.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,293.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,293.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,293.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,293.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
|
IP
|
$8,587.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,717.40 |
| Max. Negotiated Rate |
$7,728.30 |
| Rate for Payer: Adventist Health Commercial |
$1,717.40
|
| Rate for Payer: Cash Price |
$4,722.85
|
| Rate for Payer: Central Health Plan Commercial |
$6,869.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,434.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,434.80
|
| Rate for Payer: Galaxy Health WC |
$7,298.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,152.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,728.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,727.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,271.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,315.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.40
|
| Rate for Payer: Multiplan Commercial |
$6,440.25
|
| Rate for Payer: Networks By Design Commercial |
$5,581.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,298.95
|
|
|
HC CL TREAT OF PAT DISC W/ANESTH
|
Facility
|
OP
|
$7,181.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| 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 |
$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 |
$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 |
$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 |
$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 |
$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 |
$4,789.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.20
|
| 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 |
$5,385.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$4,667.65
|
| 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 |
$6,103.85
|
| 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 |
$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 |
$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 OF PAT DISC W/ANESTH
|
Facility
|
IP
|
$7,181.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
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 OF PAT DISC W/O ANEST
|
Facility
|
IP
|
$2,859.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
900501088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$571.80 |
| Max. Negotiated Rate |
$2,573.10 |
| Rate for Payer: Adventist Health Commercial |
$571.80
|
| Rate for Payer: Cash Price |
$1,572.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,287.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,143.60
|
| Rate for Payer: Galaxy Health WC |
$2,430.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,715.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,573.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,906.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,089.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,769.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$571.80
|
| Rate for Payer: Multiplan Commercial |
$2,144.25
|
| Rate for Payer: Networks By Design Commercial |
$1,858.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,430.15
|
|
