|
HC CL TREAT FEMORAL SHAFT FX,W/O
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
900501463
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$1,161.95 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.85
|
| Rate for Payer: Blue Shield of California EPN |
$664.36
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$546.80
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$846.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
|
|
HC CL TREAT FEM SHAFT FRAC W/MANI
|
Facility
|
IP
|
$4,642.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
900501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$928.40 |
| Max. Negotiated Rate |
$3,945.70 |
| Rate for Payer: Adventist Health Commercial |
$928.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,425.80
|
| Rate for Payer: Blue Shield of California EPN |
$2,256.01
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,856.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,856.80
|
| Rate for Payer: Galaxy Health WC |
$3,945.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,873.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.08
|
| Rate for Payer: Multiplan Commercial |
$3,713.60
|
| Rate for Payer: Networks By Design Commercial |
$3,017.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,945.70
|
|
|
HC CL TREAT FEM SHAFT FRAC W/MANI
|
Facility
|
OP
|
$4,642.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
900501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$679.78 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$928.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Cigna of CA HMO |
$2,970.88
|
| Rate for Payer: Cigna of CA PPO |
$3,435.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$3,945.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$679.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,114.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$3,713.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,017.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,945.70
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,785.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,321.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,321.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,321.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,321.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT FIBULA FX W/MANIPULAT
|
Facility
|
OP
|
$5,369.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
900501487
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$797.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: Cigna of CA HMO |
$3,436.16
|
| Rate for Payer: Cigna of CA PPO |
$3,973.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$4,563.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,221.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,581.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$4,295.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,489.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,563.65
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,221.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,684.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,684.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,684.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,684.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT FIBULA FX W/MANIPULAT
|
Facility
|
IP
|
$5,369.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
900501487
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,073.80 |
| Max. Negotiated Rate |
$4,563.65 |
| Rate for Payer: Adventist Health Commercial |
$1,073.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,962.32
|
| Rate for Payer: Blue Shield of California EPN |
$2,609.33
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,147.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,147.60
|
| Rate for Payer: Galaxy Health WC |
$4,563.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,221.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,581.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,045.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,323.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.56
|
| Rate for Payer: Multiplan Commercial |
$4,295.20
|
| Rate for Payer: Networks By Design Commercial |
$3,489.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,563.65
|
|
|
HC CL TREAT FIBULA/SHAFT FX W/O M
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
900501759
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna of CA HMO |
$359.68
|
| Rate for Payer: Cigna of CA PPO |
$415.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$281.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$281.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$281.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT FIBULA/SHAFT FX W/O M
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
900501759
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$477.70 |
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Blue Shield of California Commercial |
$414.76
|
| Rate for Payer: Blue Shield of California EPN |
$273.13
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.80
|
| Rate for Payer: EPIC Health Plan Senior |
$224.80
|
| Rate for Payer: Galaxy Health WC |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.88
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
|
|
HC CL TREAT FINGER/THUMB FX W/O M
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
900501393
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.40 |
| Max. Negotiated Rate |
$1,161.95 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.80
|
| Rate for Payer: EPIC Health Plan Senior |
$546.80
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$520.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$846.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
|
|
HC CL TREAT FINGER/THUMB FX W/O M
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
900501393
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cash Price |
$615.15
|
| Rate for Payer: Cigna of CA HMO |
$874.88
|
| Rate for Payer: Cigna of CA PPO |
$1,011.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,161.95
|
| Rate for Payer: Global Benefits Group Commercial |
$820.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$911.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$888.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,161.95
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$820.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$683.50
|
| Rate for Payer: United Healthcare All Other HMO |
$683.50
|
| Rate for Payer: United Healthcare HMO Rider |
$683.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$683.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT FOOT DISLOCAT W/O ANE
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
900501655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$667.25 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$485.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC CL TREAT FOOT DISLOCAT W/O ANE
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
900501655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$523.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$392.50
|
| Rate for Payer: United Healthcare All Other HMO |
$392.50
|
| Rate for Payer: United Healthcare HMO Rider |
$392.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$392.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT FRAC OF WT BEAR W/SKE
|
Facility
|
OP
|
$4,681.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
900501095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.91 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$936.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,106.45
|
| Rate for Payer: Cash Price |
$2,106.45
|
| Rate for Payer: Cash Price |
$2,106.45
|
| Rate for Payer: Cigna of CA HMO |
$2,995.84
|
| Rate for Payer: Cigna of CA PPO |
$3,463.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$3,978.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,808.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,122.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$3,744.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,042.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,978.85
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,808.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,340.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,340.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,340.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,340.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT FRAC OF WT BEAR W/SKE
|
Facility
|
IP
|
$4,681.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
900501095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.20 |
| Max. Negotiated Rate |
$3,978.85 |
| Rate for Payer: Adventist Health Commercial |
$936.20
|
| Rate for Payer: Cash Price |
$2,106.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,872.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,872.40
|
| Rate for Payer: Galaxy Health WC |
$3,978.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,808.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,122.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,783.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.44
|
| Rate for Payer: Multiplan Commercial |
$3,744.80
|
| Rate for Payer: Networks By Design Commercial |
$3,042.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,978.85
|
|
|
HC CL TREAT FX OF WT BRNG LWR LEG
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
900501502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.80 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cigna of CA HMO |
$536.96
|
| Rate for Payer: Cigna of CA PPO |
$620.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$503.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$419.50
|
| Rate for Payer: United Healthcare All Other HMO |
$419.50
|
| Rate for Payer: United Healthcare HMO Rider |
$419.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$419.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT FX OF WT BRNG LWR LEG
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
900501502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.80 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.60
|
| Rate for Payer: EPIC Health Plan Senior |
$335.60
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$519.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.36
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
|
|
HC CL TREAT FX ORBIT, W/O MANIPUL
|
Facility
|
OP
|
$2,941.00
|
|
|
Service Code
|
CPT 21400
|
| Hospital Charge Code |
900501526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.10 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$588.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,323.45
|
| Rate for Payer: Cash Price |
$1,323.45
|
| Rate for Payer: Cash Price |
$1,323.45
|
| Rate for Payer: Cigna of CA HMO |
$1,882.24
|
| Rate for Payer: Cigna of CA PPO |
$2,176.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$2,499.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,961.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$2,352.80
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,911.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.85
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,764.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,470.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,470.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,470.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,470.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC CL TREAT FX ORBIT, W/O MANIPUL
|
Facility
|
IP
|
$2,941.00
|
|
|
Service Code
|
CPT 21400
|
| Hospital Charge Code |
900501526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$588.20 |
| Max. Negotiated Rate |
$2,499.85 |
| Rate for Payer: Adventist Health Commercial |
$588.20
|
| Rate for Payer: Cash Price |
$1,323.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,176.40
|
| Rate for Payer: Galaxy Health WC |
$2,499.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,764.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,961.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,120.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,820.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.84
|
| Rate for Payer: Multiplan Commercial |
$2,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,911.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,499.85
|
|
|
HC CL TREAT GRT HUMERUS FX W/MANI
|
Facility
|
IP
|
$5,650.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
900501414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,130.00 |
| Max. Negotiated Rate |
$4,802.50 |
| Rate for Payer: Adventist Health Commercial |
$1,130.00
|
| Rate for Payer: Cash Price |
$2,542.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,260.00
|
| Rate for Payer: Galaxy Health WC |
$4,802.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,768.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,152.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,497.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.00
|
| Rate for Payer: Multiplan Commercial |
$4,520.00
|
| Rate for Payer: Networks By Design Commercial |
$3,672.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,802.50
|
|
|
HC CL TREAT GRT HUMERUS FX W/MANI
|
Facility
|
OP
|
$5,650.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
900501414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,542.50
|
| Rate for Payer: Cash Price |
$2,542.50
|
| Rate for Payer: Cash Price |
$2,542.50
|
| Rate for Payer: Cigna of CA HMO |
$3,616.00
|
| Rate for Payer: Cigna of CA PPO |
$4,181.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$4,802.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,768.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$4,520.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,672.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,802.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,825.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,825.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,825.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,825.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT GRT HUMERUS FX W/O MA
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
900501476
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$341.60 |
| Max. Negotiated Rate |
$1,451.80 |
| Rate for Payer: Adventist Health Commercial |
$341.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.20
|
| Rate for Payer: EPIC Health Plan Senior |
$683.20
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,057.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
|
|
HC CL TREAT GRT HUMERUS FX W/O MA
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
900501476
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$341.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.12
|
| Rate for Payer: Cigna of CA PPO |
$1,263.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,024.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$854.00
|
| Rate for Payer: United Healthcare All Other HMO |
$854.00
|
| Rate for Payer: United Healthcare HMO Rider |
$854.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT GRT TOE FRAC W/O MANI
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
900501327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.41 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: Cigna of CA HMO |
$652.80
|
| Rate for Payer: Cigna of CA PPO |
$754.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$612.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.00
|
| Rate for Payer: United Healthcare All Other HMO |
$510.00
|
| Rate for Payer: United Healthcare HMO Rider |
$510.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT GRT TOE FRAC W/O MANI
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
900501327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$204.00 |
| Max. Negotiated Rate |
$867.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Cash Price |
$459.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$408.00
|
| Rate for Payer: EPIC Health Plan Senior |
$408.00
|
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$680.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$631.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Networks By Design Commercial |
$663.00
|
| Rate for Payer: Prime Health Services Commercial |
$867.00
|
|
|
HC CL TREAT HAND DSLOCATN W/MANIP
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
CPT 26670
|
| Hospital Charge Code |
900501506
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$921.60
|
| Rate for Payer: Cigna of CA PPO |
$1,065.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$864.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$720.00
|
| Rate for Payer: United Healthcare All Other HMO |
$720.00
|
| Rate for Payer: United Healthcare HMO Rider |
$720.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT HAND DSLOCATN W/MANIP
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
CPT 26670
|
| Hospital Charge Code |
900501506
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.00 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Adventist Health Commercial |
$288.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.00
|
| Rate for Payer: EPIC Health Plan Senior |
$576.00
|
| Rate for Payer: Galaxy Health WC |
$1,224.00
|
| Rate for Payer: Global Benefits Group Commercial |
$864.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$960.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$891.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$345.60
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$936.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,224.00
|
|
