|
HC CL TREAT SHOULDER DISLOC W/MAN
|
Facility
IP
|
$3,039.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
900501477
|
|
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 SHOULDER DISLOC W/MAN
|
Facility
OP
|
$3,039.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
900501477
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,823.40
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA PPO |
$2,248.86
|
| 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 |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,279.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| 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 |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,823.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,519.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,519.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,519.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,519.50
|
| 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 TA ANKLE FX W/O MANIP
|
Facility
IP
|
$2,009.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
900501560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$482.16 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.60
|
| Rate for Payer: Galaxy Health WC |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| Rate for Payer: Multiplan Commercial |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
|
|
HC CL TREAT TA ANKLE FX W/O MANIP
|
Facility
OP
|
$2,009.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
900501560
|
|
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: 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,205.40
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cash Price |
$904.05
|
| Rate for Payer: Cigna of CA PPO |
$1,486.66
|
| 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 |
$1,707.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,205.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,506.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,340.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$482.16
|
| 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 |
$1,607.20
|
| Rate for Payer: Networks By Design Commercial |
$1,305.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,707.65
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,205.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,205.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,004.50
|
| 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 TALUS FRAC,W/MANIP
|
Facility
IP
|
$6,140.00
|
|
|
Service Code
|
CPT 28435
|
| Hospital Charge Code |
900501235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,473.60 |
| Max. Negotiated Rate |
$5,219.00 |
| Rate for Payer: Cash Price |
$2,763.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,456.00
|
| Rate for Payer: Galaxy Health WC |
$5,219.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,095.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,339.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,473.60
|
| Rate for Payer: Multiplan Commercial |
$4,912.00
|
| Rate for Payer: Networks By Design Commercial |
$3,991.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,219.00
|
|
|
HC CL TREAT TALUS FRAC,W/MANIP
|
Facility
OP
|
$6,140.00
|
|
|
Service Code
|
CPT 28435
|
| Hospital Charge Code |
900501235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$343.79 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,684.00
|
| Rate for Payer: Cash Price |
$2,763.00
|
| Rate for Payer: Cash Price |
$2,763.00
|
| Rate for Payer: Cash Price |
$2,763.00
|
| Rate for Payer: Cigna of CA PPO |
$4,543.60
|
| 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 |
$5,219.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,684.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,605.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,095.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,473.60
|
| 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 |
$4,912.00
|
| Rate for Payer: Networks By Design Commercial |
$3,991.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,219.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,684.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,070.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,070.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,070.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,070.00
|
| 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 TALUS FX, W/O MANIPUL
|
Facility
IP
|
$1,780.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
900501475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.20 |
| Max. Negotiated Rate |
$1,513.00 |
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.00
|
| Rate for Payer: Galaxy Health WC |
$1,513.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,068.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,187.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.20
|
| Rate for Payer: Multiplan Commercial |
$1,424.00
|
| Rate for Payer: Networks By Design Commercial |
$1,157.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,513.00
|
|
|
HC CL TREAT TALUS FX, W/O MANIPUL
|
Facility
OP
|
$1,780.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
900501475
|
|
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: 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,068.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cash Price |
$801.00
|
| Rate for Payer: Cigna of CA PPO |
$1,317.20
|
| 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 |
$1,513.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,068.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,335.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,187.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.20
|
| 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 |
$1,424.00
|
| Rate for Payer: Networks By Design Commercial |
$1,157.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,513.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,068.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,068.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$890.00
|
| Rate for Payer: United Healthcare All Other HMO |
$890.00
|
| Rate for Payer: United Healthcare HMO Rider |
$890.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$890.00
|
| 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 THIGH FX
|
Facility
IP
|
$4,886.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
900501436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,172.64 |
| Max. Negotiated Rate |
$4,153.10 |
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.40
|
| Rate for Payer: Galaxy Health WC |
$4,153.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,861.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.64
|
| Rate for Payer: Multiplan Commercial |
$3,908.80
|
| Rate for Payer: Networks By Design Commercial |
$3,175.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,153.10
|
|
|
HC CL TREAT THIGH FX
|
Facility
OP
|
$4,886.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
900501436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$465.33 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,931.60
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cash Price |
$2,198.70
|
| Rate for Payer: Cigna of CA PPO |
$3,615.64
|
| 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 |
$4,153.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,931.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,664.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,258.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.64
|
| 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 |
$3,908.80
|
| Rate for Payer: Networks By Design Commercial |
$3,175.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,153.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,931.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,931.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,443.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,443.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,443.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,443.00
|
| 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 THIGH FX W/MANIP
|
Facility
OP
|
$3,767.00
|
|
|
Service Code
|
CPT 27517
|
| Hospital Charge Code |
900501685
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$904.08 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,260.20
|
| Rate for Payer: Cash Price |
$1,695.15
|
| Rate for Payer: Cash Price |
$1,695.15
|
| Rate for Payer: Cash Price |
$1,695.15
|
| Rate for Payer: Cigna of CA PPO |
$2,787.58
|
| 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 |
$3,201.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,260.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,825.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,512.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.08
|
| 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 |
$3,013.60
|
| Rate for Payer: Networks By Design Commercial |
$2,448.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,201.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,260.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,260.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,883.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,883.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,883.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,883.50
|
| 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 THIGH FX W/MANIP
|
Facility
IP
|
$3,767.00
|
|
|
Service Code
|
CPT 27517
|
| Hospital Charge Code |
900501685
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$904.08 |
| Max. Negotiated Rate |
$3,201.95 |
| Rate for Payer: Blue Shield of California Commercial |
$2,682.10
|
| Rate for Payer: Blue Shield of California EPN |
$1,928.70
|
| Rate for Payer: Cash Price |
$1,695.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,506.80
|
| Rate for Payer: Galaxy Health WC |
$3,201.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,260.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,512.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,435.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.08
|
| Rate for Payer: Multiplan Commercial |
$3,013.60
|
| Rate for Payer: Networks By Design Commercial |
$2,448.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,201.95
|
|
|
HC CL TREAT THIGH FX W/O MANIPULA
|
Facility
OP
|
$774.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
900501448
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.52 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$464.40
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| 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 |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$580.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| 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 |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$387.00
|
| Rate for Payer: United Healthcare All Other HMO |
$387.00
|
| Rate for Payer: United Healthcare HMO Rider |
$387.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$387.00
|
| 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 THIGH FX W/O MANIPULA
|
Facility
IP
|
$774.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
900501448
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.76 |
| Max. Negotiated Rate |
$657.90 |
| Rate for Payer: Blue Shield of California Commercial |
$551.09
|
| Rate for Payer: Blue Shield of California EPN |
$396.29
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.76
|
| Rate for Payer: Multiplan Commercial |
$619.20
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC CL TREAT TIBIAL FX W/O MANIPUL
|
Facility
OP
|
$1,969.00
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
900501367
|
|
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: 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$1,181.40
|
| 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 TIBIAL FX W/O MANIPUL
|
Facility
IP
|
$1,969.00
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
900501367
|
|
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 TIBIAL FX W/SKELETAL
|
Facility
OP
|
$6,647.00
|
|
|
Service Code
|
CPT 27532
|
| Hospital Charge Code |
900501554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$475.36 |
| Max. Negotiated Rate |
$6,632.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,988.20
|
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: Cigna of CA PPO |
$4,918.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$5,649.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,988.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,985.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,595.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$5,317.60
|
| Rate for Payer: Networks By Design Commercial |
$4,320.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,649.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,988.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,988.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,323.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,323.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,323.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,323.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC CL TREAT TIBIAL FX W/SKELETAL
|
Facility
IP
|
$6,647.00
|
|
|
Service Code
|
CPT 27532
|
| Hospital Charge Code |
900501554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,595.28 |
| Max. Negotiated Rate |
$5,649.95 |
| Rate for Payer: Blue Shield of California Commercial |
$4,732.66
|
| Rate for Payer: Blue Shield of California EPN |
$3,403.26
|
| Rate for Payer: Cash Price |
$2,991.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,658.80
|
| Rate for Payer: Galaxy Health WC |
$5,649.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,532.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,595.28
|
| Rate for Payer: Multiplan Commercial |
$5,317.60
|
| Rate for Payer: Networks By Design Commercial |
$4,320.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,649.95
|
|
|
HC CL TREAT TIBIA SHAFT FX W/MAN
|
Facility
OP
|
$6,610.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
900501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$5,618.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,966.00
|
| Rate for Payer: Cash Price |
$2,974.50
|
| Rate for Payer: Cash Price |
$2,974.50
|
| Rate for Payer: Cash Price |
$2,974.50
|
| Rate for Payer: Cigna of CA PPO |
$4,891.40
|
| 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 |
$5,618.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,957.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,408.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.40
|
| 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 |
$5,288.00
|
| Rate for Payer: Networks By Design Commercial |
$4,296.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,618.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,966.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,966.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,305.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,305.00
|
| 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 TIBIA SHAFT FX W/MAN
|
Facility
IP
|
$6,610.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
900501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,586.40 |
| Max. Negotiated Rate |
$5,618.50 |
| Rate for Payer: Blue Shield of California Commercial |
$4,706.32
|
| Rate for Payer: Blue Shield of California EPN |
$3,384.32
|
| Rate for Payer: Cash Price |
$2,974.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,644.00
|
| Rate for Payer: Galaxy Health WC |
$5,618.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,408.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,518.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,586.40
|
| Rate for Payer: Multiplan Commercial |
$5,288.00
|
| Rate for Payer: Networks By Design Commercial |
$4,296.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,618.50
|
|
|
HC CL TREAT TOE DSLOCATN W/O ANES
|
Facility
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
900501409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.72 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant 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 Transplant 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: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: 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 |
$116.72
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$964.80
|
| 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 TOE DSLOCATN W/O ANES
|
Facility
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
900501409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| 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 TOE FX WO MAN EA
|
Facility
IP
|
$1,666.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
900501489
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$1,416.10 |
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$666.40
|
| Rate for Payer: Galaxy Health WC |
$1,416.10
|
| Rate for Payer: Global Benefits Group Commercial |
$999.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,111.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$634.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.84
|
| Rate for Payer: Multiplan Commercial |
$1,332.80
|
| Rate for Payer: Networks By Design Commercial |
$1,082.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,416.10
|
|
|
HC CL TREAT TOE FX WO MAN EA
|
Facility
OP
|
$1,666.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
900501489
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.69 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$999.60
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cash Price |
$749.70
|
| Rate for Payer: Cigna of CA PPO |
$1,232.84
|
| 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 |
$1,416.10
|
| Rate for Payer: Global Benefits Group Commercial |
$999.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,249.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,111.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.84
|
| 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 |
$1,332.80
|
| Rate for Payer: Networks By Design Commercial |
$1,082.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,416.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$999.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$999.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$833.00
|
| Rate for Payer: United Healthcare All Other HMO |
$833.00
|
| Rate for Payer: United Healthcare HMO Rider |
$833.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$833.00
|
| 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 TRIMALLOR FX W/MANIPU
|
Facility
OP
|
$4,378.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
900501094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| 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 HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,626.80
|
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: Cash Price |
$1,970.10
|
| Rate for Payer: Cigna of CA PPO |
$3,239.72
|
| 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 |
$3,721.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,626.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,283.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,293.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,293.27
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,920.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,050.72
|
| 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 |
$3,502.40
|
| Rate for Payer: Networks By Design Commercial |
$2,845.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,721.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,626.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,626.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,189.00
|
| 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
|
|
