|
HC CL TREAT CARPAL BONE FX W/MANI
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT 25635
|
| Hospital Charge Code |
900501382
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
|
|
HC CL TREAT CARPAL SCAPHOID FX W/
|
Facility
|
IP
|
$4,115.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
900501381
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$987.60 |
| Max. Negotiated Rate |
$3,497.75 |
| Rate for Payer: Cash Price |
$1,851.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,646.00
|
| Rate for Payer: Galaxy Health WC |
$3,497.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,469.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,744.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,567.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$987.60
|
| Rate for Payer: Multiplan Commercial |
$3,292.00
|
| Rate for Payer: Networks By Design Commercial |
$2,674.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,497.75
|
|
|
HC CL TREAT CARPAL SCAPHOID FX W/
|
Facility
|
OP
|
$4,115.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
900501381
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$448.48 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,469.00
|
| Rate for Payer: Cash Price |
$1,851.75
|
| Rate for Payer: Cash Price |
$1,851.75
|
| Rate for Payer: Cash Price |
$1,851.75
|
| Rate for Payer: Cigna of CA PPO |
$3,045.10
|
| 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 |
$3,497.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,469.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,086.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,744.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$448.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$987.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$3,292.00
|
| Rate for Payer: Networks By Design Commercial |
$2,674.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,497.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,469.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,057.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,057.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,057.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,057.50
|
| 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 CARPO DIS THMB W/MANI
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
900501077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.48 |
| Max. Negotiated Rate |
$1,637.95 |
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.80
|
| Rate for Payer: Galaxy Health WC |
$1,637.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,156.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.48
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Networks By Design Commercial |
$1,252.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.95
|
|
|
HC CL TREAT CARPO DIS THMB W/MANI
|
Facility
|
OP
|
$1,927.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
900501077
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,156.20
|
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: Cigna of CA PPO |
$1,425.98
|
| 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 |
$1,637.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,156.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,445.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Networks By Design Commercial |
$1,252.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,156.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$963.50
|
| 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 DIST FIB FRAC W/O MAN
|
Facility
|
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
900501092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,181.40
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cash Price |
$886.05
|
| Rate for Payer: Cigna of CA PPO |
$1,457.06
|
| 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 |
$1,673.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,181.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,476.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$330.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
| 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 DIST FIB FRAC W/O MAN
|
Facility
|
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 27786
|
| Hospital Charge Code |
900501092
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.56 |
| Max. Negotiated Rate |
$1,673.65 |
| Rate for Payer: Blue Shield of California Commercial |
$1,401.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,008.13
|
| Rate for Payer: Cash Price |
$886.05
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$1,313.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$750.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$472.56
|
| Rate for Payer: Multiplan Commercial |
$1,575.20
|
| Rate for Payer: Networks By Design Commercial |
$1,279.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,673.65
|
|
|
HC CL TREAT DIST FIB FX W/MANIP
|
Facility
|
OP
|
$2,600.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
900501234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,560.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: Cigna of CA PPO |
$1,924.00
|
| 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 |
$2,210.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,560.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,950.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,734.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$419.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$2,080.00
|
| Rate for Payer: Networks By Design Commercial |
$1,690.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,300.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,300.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,300.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,300.00
|
| 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 DIST FIB FX W/MANIP
|
Facility
|
IP
|
$2,600.00
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
900501234
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,210.00 |
| Rate for Payer: Blue Shield of California Commercial |
$1,851.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,040.00
|
| Rate for Payer: Galaxy Health WC |
$2,210.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,560.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,734.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$990.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$2,080.00
|
| Rate for Payer: Networks By Design Commercial |
$1,690.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,210.00
|
|
|
HC CL TREAT DIST PHAL FX W/MANIPU
|
Facility
|
OP
|
$2,514.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
900501324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$243.33 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,508.40
|
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: Cigna of CA PPO |
$1,860.36
|
| 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 |
$2,136.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,508.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,885.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$2,011.20
|
| Rate for Payer: Networks By Design Commercial |
$1,634.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,257.00
|
| 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 DIST PHAL FX W/MANIPU
|
Facility
|
IP
|
$2,514.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
900501324
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$603.36 |
| Max. Negotiated Rate |
$2,136.90 |
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,005.60
|
| Rate for Payer: Galaxy Health WC |
$2,136.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,508.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$957.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.36
|
| Rate for Payer: Multiplan Commercial |
$2,011.20
|
| Rate for Payer: Networks By Design Commercial |
$1,634.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.90
|
|
|
HC CL TREAT DIST PHAL FX W/O MANI
|
Facility
|
IP
|
$2,029.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
900501362
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$486.96 |
| Max. Negotiated Rate |
$1,724.65 |
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$811.60
|
| Rate for Payer: Galaxy Health WC |
$1,724.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,217.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$773.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.96
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: Networks By Design Commercial |
$1,318.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,724.65
|
|
|
HC CL TREAT DIST PHAL FX W/O MANI
|
Facility
|
OP
|
$2,029.00
|
|
|
Service Code
|
CPT 26750
|
| Hospital Charge Code |
900501362
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.52 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,217.40
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cash Price |
$913.05
|
| Rate for Payer: Cigna of CA PPO |
$1,501.46
|
| 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 |
$1,724.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,217.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,521.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,353.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,623.20
|
| Rate for Payer: Networks By Design Commercial |
$1,318.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,724.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,217.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,014.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,014.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,014.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,014.50
|
| 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 ELBOW DISLOC W O ANES
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
900501063
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: Cigna of CA PPO |
$1,660.56
|
| 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 |
$1,907.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,346.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,683.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,496.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,795.20
|
| Rate for Payer: Networks By Design Commercial |
$1,458.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,907.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,346.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,122.00
|
| 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 ELBOW DISLOC W O ANES
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
900501063
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$538.56 |
| Max. Negotiated Rate |
$1,907.40 |
| Rate for Payer: Cash Price |
$1,009.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$897.60
|
| Rate for Payer: Galaxy Health WC |
$1,907.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,346.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,496.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$854.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$538.56
|
| Rate for Payer: Multiplan Commercial |
$1,795.20
|
| Rate for Payer: Networks By Design Commercial |
$1,458.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,907.40
|
|
|
HC CL TREAT FEM FX,INTER EXT W/MA
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
CPT 27503
|
| Hospital Charge Code |
900501522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.85 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cigna of CA PPO |
$1,858.14
|
| 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 |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,883.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,506.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,255.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,255.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,255.50
|
| 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 FEM FX,INTER EXT W/MA
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
CPT 27503
|
| Hospital Charge Code |
900501522
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1,787.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,285.63
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.40
|
| Rate for Payer: Galaxy Health WC |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
|
|
HC CL TREAT FEMORAL FX W/ MANIPUL
|
Facility
|
OP
|
$6,507.00
|
|
|
Service Code
|
CPT 27232
|
| Hospital Charge Code |
900501442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.08 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,530.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,578.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,578.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,904.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,928.15
|
| Rate for Payer: Cash Price |
$2,928.15
|
| Rate for Payer: Cigna of CA PPO |
$4,815.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,530.95
|
| Rate for Payer: Dignity Health Media |
$5,530.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,530.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,602.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,602.80
|
| Rate for Payer: Galaxy Health WC |
$5,530.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,880.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.68
|
| Rate for Payer: Multiplan Commercial |
$5,205.60
|
| Rate for Payer: Networks By Design Commercial |
$4,229.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,530.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,904.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,530.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,530.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,530.95
|
|
|
HC CL TREAT FEMORAL FX W/ MANIPUL
|
Facility
|
IP
|
$6,507.00
|
|
|
Service Code
|
CPT 27232
|
| Hospital Charge Code |
900501442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,561.68 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,928.15
|
| Rate for Payer: Cash Price |
$2,928.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,602.80
|
| Rate for Payer: Galaxy Health WC |
$5,530.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,904.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,340.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,479.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,561.68
|
| Rate for Payer: Multiplan Commercial |
$5,205.60
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,530.95
|
|
|
HC CL TREAT FEMORAL FX, W MANIPUL
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
900501427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Blue Shield of California Commercial |
$1,787.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,285.63
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.40
|
| Rate for Payer: Galaxy Health WC |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
|
|
HC CL TREAT FEMORAL FX, W MANIPUL
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
900501427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cigna of CA PPO |
$1,858.14
|
| 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 |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,883.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,506.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,255.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,255.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,255.50
|
| 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 FEMORAL FX, W/O MANIP
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
900501482
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1,144.90
|
| Rate for Payer: Blue Shield of California EPN |
$823.30
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC CL TREAT FEMORAL FX, W/O MANIP
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
900501482
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| 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 |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.00
|
| Rate for Payer: United Healthcare All Other HMO |
$804.00
|
| Rate for Payer: United Healthcare HMO Rider |
$804.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.00
|
| 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 FEMORAL SHAFT FX,W/O
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
900501463
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| 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 |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.00
|
| Rate for Payer: United Healthcare All Other HMO |
$804.00
|
| Rate for Payer: United Healthcare HMO Rider |
$804.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.00
|
| 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 FEMORAL SHAFT FX,W/O
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
900501463
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1,144.90
|
| Rate for Payer: Blue Shield of California EPN |
$823.30
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
