|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$500.40
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Central Health Plan Commercial |
$667.20
|
| Rate for Payer: Cigna of CA PPO |
$617.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$750.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$625.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
| Rate for Payer: Networks By Design Commercial |
$542.10
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$500.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$417.00
|
| Rate for Payer: United Healthcare HMO Rider |
$417.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$417.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
OP
|
$5,293.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,632.50 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,175.80
|
| Rate for Payer: Caremore Medicare Advantage |
$4,044.21
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,234.40
|
| Rate for Payer: Cigna of CA PPO |
$3,916.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$4,499.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,175.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,763.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,969.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: InnovAge PACE Commercial |
$6,066.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,530.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$756.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,419.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
| Rate for Payer: Networks By Design Commercial |
$3,440.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,499.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,286.86
|
| Rate for Payer: Riverside University Health System MISP |
$4,448.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,175.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,646.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,646.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,646.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,646.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
IP
|
$5,293.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,058.60 |
| Max. Negotiated Rate |
$4,763.70 |
| Rate for Payer: Cash Price |
$2,381.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,234.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,117.20
|
| Rate for Payer: Galaxy Health WC |
$4,499.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,175.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,763.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,530.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,016.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.60
|
| Rate for Payer: Multiplan Commercial |
$3,969.75
|
| Rate for Payer: Networks By Design Commercial |
$3,440.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,499.05
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$881.10 |
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Central Health Plan Commercial |
$783.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.60
|
| Rate for Payer: Galaxy Health WC |
$832.15
|
| Rate for Payer: Global Benefits Group Commercial |
$587.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$881.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.80
|
| Rate for Payer: Multiplan Commercial |
$734.25
|
| Rate for Payer: Networks By Design Commercial |
$636.35
|
| Rate for Payer: Prime Health Services Commercial |
$832.15
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$587.40
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Central Health Plan Commercial |
$783.20
|
| Rate for Payer: Cigna of CA PPO |
$724.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$832.15
|
| Rate for Payer: Global Benefits Group Commercial |
$587.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$881.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$734.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$734.25
|
| Rate for Payer: Networks By Design Commercial |
$636.35
|
| Rate for Payer: Prime Health Services Commercial |
$832.15
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$587.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.50
|
| Rate for Payer: United Healthcare All Other HMO |
$489.50
|
| Rate for Payer: United Healthcare HMO Rider |
$489.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.94 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$982.80
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,310.40
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,474.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,228.50
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$819.00
|
| Rate for Payer: United Healthcare All Other HMO |
$819.00
|
| Rate for Payer: United Healthcare HMO Rider |
$819.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$1,474.20 |
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Central Health Plan Commercial |
$1,310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,474.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.60
|
| Rate for Payer: Multiplan Commercial |
$1,228.50
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
IP
|
$2,279.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.80 |
| Max. Negotiated Rate |
$2,051.10 |
| Rate for Payer: Blue Shield of California Commercial |
$1,709.25
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.60
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,051.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$868.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.80
|
| Rate for Payer: Multiplan Commercial |
$1,709.25
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
OP
|
$2,279.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$3,293.27 |
| 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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,367.40
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Cash Price |
$1,025.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,823.20
|
| Rate for Payer: Cigna of CA PPO |
$1,686.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$1,937.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,367.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,051.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,709.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,520.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$455.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$1,709.25
|
| Rate for Payer: Networks By Design Commercial |
$1,481.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,937.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,367.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,139.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,139.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,139.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,139.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.36
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Adventist Health Medi-Cal |
$11.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.75
|
| Rate for Payer: Blue Distinction Transplant |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28.43
|
| Rate for Payer: Blue Shield of California EPN |
$22.36
|
| Rate for Payer: Caremore Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Central Health Plan Commercial |
$36.80
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: InnovAge PACE Commercial |
$17.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Prime Health Services Medicare |
$12.70
|
| Rate for Payer: Riverside University Health System MISP |
$13.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Blue Shield of California EPN |
$540.41
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.13
|
| Rate for Payer: United Healthcare All Other HMO |
$373.23
|
| Rate for Payer: United Healthcare HMO Rider |
$365.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.96
|
|
|
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: 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 |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$462.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$563.68
|
| Rate for Payer: Blue Distinction Transplant |
$607.20
|
| Rate for Payer: Blue Shield of California Commercial |
$759.00
|
| Rate for Payer: Blue Shield of California EPN |
$550.53
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$708.40
|
| Rate for Payer: Cigna of CA PPO |
$708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Media |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.20
|
| 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: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$506.00
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: 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 |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| 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
|
$2,515.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$3,293.27 |
| 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 |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,509.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,012.00
|
| Rate for Payer: Cigna of CA PPO |
$1,861.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,263.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,886.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,509.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$503.00 |
| Max. Negotiated Rate |
$2,263.50 |
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,012.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,006.00
|
| Rate for Payer: Galaxy Health WC |
$2,137.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,509.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,263.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,677.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$958.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.00
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
| Rate for Payer: Networks By Design Commercial |
$1,634.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,137.75
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$726.30 |
| Rate for Payer: Blue Shield of California Commercial |
$605.25
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.40
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$524.55
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$484.20
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: Cigna of CA PPO |
$597.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$605.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$524.55
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$403.50
|
| Rate for Payer: United Healthcare All Other HMO |
$403.50
|
| Rate for Payer: United Healthcare HMO Rider |
$403.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$403.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
|
IP
|
$10,306.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,061.20 |
| Max. Negotiated Rate |
$9,275.40 |
| Rate for Payer: Cash Price |
$4,637.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,122.40
|
| Rate for Payer: Galaxy Health WC |
$8,760.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,874.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,926.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.20
|
| Rate for Payer: Multiplan Commercial |
$7,729.50
|
| Rate for Payer: Networks By Design Commercial |
$6,698.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.10
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
|
OP
|
$10,306.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,140.28 |
| Max. Negotiated Rate |
$9,275.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,061.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,760.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,668.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,668.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,183.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$4,637.70
|
| Rate for Payer: Cash Price |
$4,637.70
|
| Rate for Payer: Central Health Plan Commercial |
$8,244.80
|
| Rate for Payer: Cigna of CA PPO |
$7,626.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,760.10
|
| Rate for Payer: Dignity Health Media |
$8,760.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,760.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,122.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,122.40
|
| Rate for Payer: Galaxy Health WC |
$8,760.10
|
| Rate for Payer: Global Benefits Group Commercial |
$6,183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,275.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,729.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,607.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,874.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,140.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,061.20
|
| Rate for Payer: Multiplan Commercial |
$7,729.50
|
| Rate for Payer: Networks By Design Commercial |
$6,698.90
|
| Rate for Payer: Prime Health Services Commercial |
$8,760.10
|
| Rate for Payer: Riverside University Health System MISP |
$4,122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,183.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,760.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,760.10
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$294.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,465.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,194.63
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,954.40
|
| Rate for Payer: Cigna of CA HMO |
$1,563.52
|
| Rate for Payer: Cigna of CA PPO |
$1,807.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,198.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,832.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$486.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,832.25
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,465.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,465.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,221.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,221.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,221.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,465.80
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,954.40
|
| Rate for Payer: Cigna of CA PPO |
$1,807.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,198.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,832.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: InnovAge PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,832.25
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Riverside University Health System MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,465.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,221.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,221.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,221.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$488.60 |
| Max. Negotiated Rate |
$2,198.70 |
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$977.20
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,198.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$1,832.25
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$488.60 |
| Max. Negotiated Rate |
$2,198.70 |
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,954.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$977.20
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,198.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$930.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.60
|
| Rate for Payer: Multiplan Commercial |
$1,832.25
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
|
