|
HC CL TREAT OF META FRAC SIN W/O
|
Facility
IP
|
$6,356.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,271.20 |
| Max. Negotiated Rate |
$5,720.40 |
| Rate for Payer: Cash Price |
$2,860.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,084.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,542.40
|
| Rate for Payer: Galaxy Health WC |
$5,402.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,720.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,239.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,271.20
|
| Rate for Payer: Multiplan Commercial |
$4,767.00
|
| Rate for Payer: Networks By Design Commercial |
$4,131.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,402.60
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$1,760.40 |
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,760.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.20
|
| Rate for Payer: Multiplan Commercial |
$1,467.00
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,173.60
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,564.80
|
| Rate for Payer: Cigna of CA PPO |
$1,447.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| 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 |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,760.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,467.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.20
|
| 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 |
$1,467.00
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,173.60
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$978.00
|
| Rate for Payer: United Healthcare All Other HMO |
$978.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$978.00
|
| 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 CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
IP
|
$5,488.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,097.60 |
| Max. Negotiated Rate |
$4,939.20 |
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.20
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,939.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.60
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
OP
|
$5,488.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,097.60 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| 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: BCBS Transplant Transplant |
$3,292.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,451.95
|
| Rate for Payer: Blue Shield of California EPN |
$2,683.63
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,390.40
|
| Rate for Payer: Cigna of CA HMO |
$3,512.32
|
| Rate for Payer: Cigna of CA PPO |
$4,061.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,939.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,116.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$3,143.98
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,292.80
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,292.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,744.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,744.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,744.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,744.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
IP
|
$5,488.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,097.60 |
| Max. Negotiated Rate |
$4,939.20 |
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.20
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,939.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,660.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.60
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
OP
|
$5,488.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| 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: BCBS Transplant Transplant |
$3,292.80
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,390.40
|
| Rate for Payer: Cigna of CA PPO |
$4,061.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,939.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,116.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Innovage PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,292.80
|
| Rate for Payer: Riverside University Health MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,292.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,744.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,744.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,744.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,744.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
IP
|
$6,493.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,298.60 |
| Max. Negotiated Rate |
$5,843.70 |
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,597.20
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,843.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.60
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
OP
|
$6,493.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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: BCBS Transplant Transplant |
$3,895.80
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Cash Price |
$2,921.85
|
| Rate for Payer: Central Health Plan Commercial |
$5,194.40
|
| Rate for Payer: Cigna of CA PPO |
$4,804.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$5,519.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,895.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,843.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,869.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,330.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,298.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,869.75
|
| Rate for Payer: Networks By Design Commercial |
$4,220.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,519.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,895.80
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,895.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC CL TREAT OF PAT DISC W/ANESTH
|
Facility
IP
|
$5,430.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,086.00 |
| Max. Negotiated Rate |
$4,887.00 |
| Rate for Payer: Blue Shield of California Commercial |
$4,072.50
|
| Rate for Payer: Cash Price |
$2,443.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,344.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,172.00
|
| Rate for Payer: Galaxy Health WC |
$4,615.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,887.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,621.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.00
|
| Rate for Payer: Multiplan Commercial |
$4,072.50
|
| Rate for Payer: Networks By Design Commercial |
$3,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,615.50
|
|
|
HC CL TREAT OF PAT DISC W/ANESTH
|
Facility
OP
|
$5,430.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,887.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$3,258.00
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$2,443.50
|
| Rate for Payer: Cash Price |
$2,443.50
|
| Rate for Payer: Cash Price |
$2,443.50
|
| Rate for Payer: Cash Price |
$2,443.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,344.00
|
| Rate for Payer: Cigna of CA PPO |
$4,018.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| 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 |
$4,615.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,887.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,072.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,621.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,086.00
|
| 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 |
$4,072.50
|
| Rate for Payer: Networks By Design Commercial |
$3,529.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,615.50
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,258.00
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,715.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,715.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,715.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,715.00
|
| 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 CL TREAT OF PAT DISC W/O ANEST
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
900501088
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,297.20
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: Cigna of CA PPO |
$1,599.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| 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 |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,621.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.40
|
| 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 |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,297.20
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,297.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,081.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,081.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,081.00
|
| 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 CL TREAT OF PAT DISC W/O ANEST
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
900501088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.40 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1,621.50
|
| Rate for Payer: Cash Price |
$972.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,729.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$864.80
|
| Rate for Payer: Galaxy Health WC |
$1,837.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,297.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,945.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,442.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$1,621.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,837.70
|
|
|
HC CL TREAT OF PATELLAR FX,W/O MA
|
Facility
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Blue Shield of California Commercial |
$1,476.75
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
|
|
HC CL TREAT OF PATELLAR FX,W/O MA
|
Facility
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,181.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,238.50
|
| Rate for Payer: Blue Shield of California EPN |
$962.84
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Cigna of CA HMO |
$1,260.16
|
| Rate for Payer: Cigna of CA PPO |
$1,457.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| 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 |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,476.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$486.16
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| 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 |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,181.40
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$984.50
|
| Rate for Payer: United Healthcare All Other HMO |
$984.50
|
| Rate for Payer: United Healthcare HMO Rider |
$984.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.50
|
| 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 OF PATELLAR FX,W/O MA
|
Facility
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$393.80 |
| Max. Negotiated Rate |
$1,772.10 |
| Rate for Payer: Blue Shield of California Commercial |
$1,476.75
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$787.60
|
| Rate for Payer: Galaxy Health WC |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| Rate for Payer: Multiplan Commercial |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
|
|
HC CL TREAT OF PATELLAR FX,W/O MA
|
Facility
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
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: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,181.40
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,575.20
|
| Rate for Payer: Cigna of CA PPO |
$1,457.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| 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 |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,772.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,476.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.80
|
| 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 |
$1,476.75
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,181.40
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,181.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$984.50
|
| Rate for Payer: United Healthcare All Other HMO |
$984.50
|
| Rate for Payer: United Healthcare HMO Rider |
$984.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$984.50
|
| 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 OF PROX HUM FRAC W/MA
|
Facility
OP
|
$6,316.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
900501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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: BCBS Transplant Transplant |
$3,789.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,052.80
|
| Rate for Payer: Cigna of CA PPO |
$4,673.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| 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 |
$5,368.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,684.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,737.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: 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 |
$4,212.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.20
|
| 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 |
$4,737.00
|
| Rate for Payer: Networks By Design Commercial |
$4,105.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,368.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,789.60
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,158.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,158.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,158.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,158.00
|
| 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 CL TREAT OF PROX HUM FRAC W/MA
|
Facility
IP
|
$6,316.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
900501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,263.20 |
| Max. Negotiated Rate |
$5,684.40 |
| Rate for Payer: Cash Price |
$2,842.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,052.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,526.40
|
| Rate for Payer: Galaxy Health WC |
$5,368.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,684.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,212.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.20
|
| Rate for Payer: Multiplan Commercial |
$4,737.00
|
| Rate for Payer: Networks By Design Commercial |
$4,105.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,368.60
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$294.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$451.71
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,538.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,612.76
|
| Rate for Payer: Blue Shield of California EPN |
$1,253.80
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| 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 |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,923.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$486.16
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| 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 |
$1,923.00
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,282.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,282.00
|
| 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 CL TREAT OF RAD ELBOW CHILD
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$2,307.60 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$1,538.40
|
| Rate for Payer: Caremore Medicare Advantage |
$294.64
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| 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 |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,923.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Innovage PACE Commercial |
$441.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| 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 |
$1,923.00
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Prime Health Services Medicare |
$312.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: Riverside University Health MISP |
$324.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,282.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,282.00
|
| 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 CL TREAT OF RAD ELBOW CHILD
|
Facility
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$2,307.60 |
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,710.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC CL TREAT OF RAD & ULN SHAFT FR
|
Facility
OP
|
$3,781.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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: BCBS Transplant Transplant |
$2,268.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,024.80
|
| Rate for Payer: Cigna of CA PPO |
$2,797.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| 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 |
$3,213.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,268.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,402.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,835.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: 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 |
$2,521.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.20
|
| 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 |
$2,835.75
|
| Rate for Payer: Networks By Design Commercial |
$2,457.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,213.85
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,268.60
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,268.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,890.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,890.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,890.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,890.50
|
| 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 CL TREAT OF RAD & ULN SHAFT FR
|
Facility
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$756.20 |
| Max. Negotiated Rate |
$3,402.90 |
| Rate for Payer: Cash Price |
$1,701.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,024.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,512.40
|
| Rate for Payer: Galaxy Health WC |
$3,213.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,268.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,402.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,521.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.20
|
| Rate for Payer: Multiplan Commercial |
$2,835.75
|
| Rate for Payer: Networks By Design Commercial |
$2,457.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,213.85
|
|
