|
HC CL TREAT SHLDR DISLO/FX W/MANI
|
Facility
|
OP
|
$3,230.00
|
|
|
Service Code
|
CPT 23665
|
| Hospital Charge Code |
900501501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$646.00
|
| 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 |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cash Price |
$1,453.50
|
| Rate for Payer: Cigna of CA HMO |
$2,067.20
|
| Rate for Payer: Cigna of CA PPO |
$2,390.20
|
| 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 |
$2,745.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,938.00
|
| 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 |
$2,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$775.20
|
| 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 |
$2,584.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,099.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,745.50
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,938.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,615.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,615.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,615.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,615.00
|
| 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 SHOULDER DISLOC W/MAN
|
Facility
|
IP
|
$2,583.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
900501477
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$2,195.55 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,033.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,033.20
|
| Rate for Payer: Galaxy Health WC |
$2,195.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,722.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$984.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,598.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.92
|
| Rate for Payer: Multiplan Commercial |
$2,066.40
|
| Rate for Payer: Networks By Design Commercial |
$1,678.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,195.55
|
|
|
HC CL TREAT SHOULDER DISLOC W/MAN
|
Facility
|
OP
|
$2,583.00
|
|
|
Service Code
|
CPT 23675
|
| Hospital Charge Code |
900501477
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$516.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$516.60
|
| 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 |
$1,162.35
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: Cash Price |
$1,162.35
|
| Rate for Payer: Cigna of CA HMO |
$1,653.12
|
| Rate for Payer: Cigna of CA PPO |
$1,911.42
|
| 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 |
$2,195.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,549.80
|
| 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 |
$1,722.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$619.92
|
| 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 |
$2,066.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,678.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,195.55
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,549.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,291.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,291.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,291.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,291.50
|
| 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 TA ANKLE FX W/O MANIP
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
900501560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| 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 |
$347.64
|
| 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 TA ANKLE FX W/O MANIP
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 27816
|
| Hospital Charge Code |
900501560
|
|
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 TALUS FRAC,W/MANIP
|
Facility
|
OP
|
$6,002.00
|
|
|
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: Adventist Health Commercial |
$1,200.40
|
| 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 |
$2,700.90
|
| Rate for Payer: Cash Price |
$2,700.90
|
| Rate for Payer: Cash Price |
$2,700.90
|
| Rate for Payer: Cigna of CA HMO |
$3,841.28
|
| Rate for Payer: Cigna of CA PPO |
$4,441.48
|
| 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 |
$5,101.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,601.20
|
| 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 |
$4,003.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$343.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.48
|
| 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 |
$4,801.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,901.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,101.70
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,001.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,001.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,001.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,001.00
|
| 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 TALUS FRAC,W/MANIP
|
Facility
|
IP
|
$6,002.00
|
|
|
Service Code
|
CPT 28435
|
| Hospital Charge Code |
900501235
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,200.40 |
| Max. Negotiated Rate |
$5,101.70 |
| Rate for Payer: Adventist Health Commercial |
$1,200.40
|
| Rate for Payer: Cash Price |
$2,700.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,400.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,400.80
|
| Rate for Payer: Galaxy Health WC |
$5,101.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,003.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,286.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,715.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.48
|
| Rate for Payer: Multiplan Commercial |
$4,801.60
|
| Rate for Payer: Networks By Design Commercial |
$3,901.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,101.70
|
|
|
HC CL TREAT TALUS FX, W/O MANIPUL
|
Facility
|
OP
|
$1,513.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
900501475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| 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 |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: Cigna of CA HMO |
$968.32
|
| Rate for Payer: Cigna of CA PPO |
$1,119.62
|
| 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 |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| 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 |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| 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 |
$1,210.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$907.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other HMO |
$756.50
|
| Rate for Payer: United Healthcare HMO Rider |
$756.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$756.50
|
| 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 TALUS FX, W/O MANIPUL
|
Facility
|
IP
|
$1,513.00
|
|
|
Service Code
|
CPT 28430
|
| Hospital Charge Code |
900501475
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.60 |
| Max. Negotiated Rate |
$1,286.05 |
| Rate for Payer: Adventist Health Commercial |
$302.60
|
| Rate for Payer: Cash Price |
$680.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$605.20
|
| Rate for Payer: EPIC Health Plan Senior |
$605.20
|
| Rate for Payer: Galaxy Health WC |
$1,286.05
|
| Rate for Payer: Global Benefits Group Commercial |
$907.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,009.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$936.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$363.12
|
| Rate for Payer: Multiplan Commercial |
$1,210.40
|
| Rate for Payer: Networks By Design Commercial |
$983.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,286.05
|
|
|
HC CL TREAT THIGH FX
|
Facility
|
IP
|
$4,153.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
900501436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$830.60 |
| Max. Negotiated Rate |
$3,530.05 |
| Rate for Payer: Adventist Health Commercial |
$830.60
|
| Rate for Payer: Cash Price |
$1,868.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,661.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,661.20
|
| Rate for Payer: Galaxy Health WC |
$3,530.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,491.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,770.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,582.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,570.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.72
|
| Rate for Payer: Multiplan Commercial |
$3,322.40
|
| Rate for Payer: Networks By Design Commercial |
$2,699.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,530.05
|
|
|
HC CL TREAT THIGH FX
|
Facility
|
OP
|
$4,153.00
|
|
|
Service Code
|
CPT 27238
|
| Hospital Charge Code |
900501436
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$465.33 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$830.60
|
| 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 |
$1,868.85
|
| Rate for Payer: Cash Price |
$1,868.85
|
| Rate for Payer: Cash Price |
$1,868.85
|
| Rate for Payer: Cigna of CA HMO |
$2,657.92
|
| Rate for Payer: Cigna of CA PPO |
$3,073.22
|
| 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 |
$3,530.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,491.80
|
| 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 |
$2,770.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$465.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$996.72
|
| 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 |
$3,322.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$2,699.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,530.05
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,491.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,076.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,076.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,076.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,076.50
|
| 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 THIGH FX W/MANIP
|
Facility
|
OP
|
$3,041.00
|
|
|
Service Code
|
CPT 27517
|
| Hospital Charge Code |
900501685
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$608.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$608.20
|
| 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 |
$1,368.45
|
| Rate for Payer: Cash Price |
$1,368.45
|
| Rate for Payer: Cash Price |
$1,368.45
|
| Rate for Payer: Cigna of CA HMO |
$1,946.24
|
| Rate for Payer: Cigna of CA PPO |
$2,250.34
|
| 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 |
$2,584.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,824.60
|
| 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 |
$2,028.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.84
|
| 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 |
$2,432.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$1,976.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,584.85
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,824.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,520.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,520.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,520.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,520.50
|
| 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 THIGH FX W/MANIP
|
Facility
|
IP
|
$3,041.00
|
|
|
Service Code
|
CPT 27517
|
| Hospital Charge Code |
900501685
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$608.20 |
| Max. Negotiated Rate |
$2,584.85 |
| Rate for Payer: Adventist Health Commercial |
$608.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,244.26
|
| Rate for Payer: Blue Shield of California EPN |
$1,477.93
|
| Rate for Payer: Cash Price |
$1,368.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,216.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,216.40
|
| Rate for Payer: Galaxy Health WC |
$2,584.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,824.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,028.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,158.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.84
|
| Rate for Payer: Multiplan Commercial |
$2,432.80
|
| Rate for Payer: Networks By Design Commercial |
$1,976.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,584.85
|
|
|
HC CL TREAT THIGH FX W/O MANIPULA
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
900501448
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$559.30 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Blue Shield of California Commercial |
$485.60
|
| Rate for Payer: Blue Shield of California EPN |
$319.79
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.20
|
| Rate for Payer: EPIC Health Plan Senior |
$263.20
|
| Rate for Payer: Galaxy Health WC |
$559.30
|
| Rate for Payer: Global Benefits Group Commercial |
$394.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$407.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.92
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: Networks By Design Commercial |
$427.70
|
| Rate for Payer: Prime Health Services Commercial |
$559.30
|
|
|
HC CL TREAT THIGH FX W/O MANIPULA
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
CPT 27501
|
| Hospital Charge Code |
900501448
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$131.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$296.10
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cash Price |
$296.10
|
| Rate for Payer: Cigna of CA HMO |
$421.12
|
| Rate for Payer: Cigna of CA PPO |
$486.92
|
| 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 |
$559.30
|
| Rate for Payer: Global Benefits Group Commercial |
$394.80
|
| 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 |
$438.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.92
|
| 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 |
$526.40
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$427.70
|
| Rate for Payer: Prime Health Services Commercial |
$559.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$329.00
|
| Rate for Payer: United Healthcare All Other HMO |
$329.00
|
| Rate for Payer: United Healthcare HMO Rider |
$329.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$329.00
|
| 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 TIBIAL FX W/O MANIPUL
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
900501367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.79 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna of CA HMO |
$1,231.36
|
| Rate for Payer: Cigna of CA PPO |
$1,423.76
|
| 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 |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| 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 |
$1,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| 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 |
$1,539.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,154.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.00
|
| 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 TIBIAL FX W/O MANIPUL
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
CPT 27530
|
| Hospital Charge Code |
900501367
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.80 |
| Max. Negotiated Rate |
$1,635.40 |
| Rate for Payer: Adventist Health Commercial |
$384.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,419.91
|
| Rate for Payer: Blue Shield of California EPN |
$935.06
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$769.60
|
| Rate for Payer: EPIC Health Plan Senior |
$769.60
|
| Rate for Payer: Galaxy Health WC |
$1,635.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,154.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,283.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,190.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.76
|
| Rate for Payer: Multiplan Commercial |
$1,539.20
|
| Rate for Payer: Networks By Design Commercial |
$1,250.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,635.40
|
|
|
HC CL TREAT TIBIAL FX W/SKELETAL
|
Facility
|
IP
|
$5,650.00
|
|
|
Service Code
|
CPT 27532
|
| Hospital Charge Code |
900501554
|
|
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: Blue Shield of California Commercial |
$4,169.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,745.90
|
| 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 TIBIAL FX W/SKELETAL
|
Facility
|
OP
|
$5,650.00
|
|
|
Service Code
|
CPT 27532
|
| Hospital Charge Code |
900501554
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$475.36 |
| Max. Negotiated Rate |
$6,761.06 |
| Rate for Payer: Adventist Health Commercial |
$1,130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| 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 |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| 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 |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,768.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$4,520.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| 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 |
$6,501.60
|
| 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 |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC CL TREAT TIBIA SHAFT FX W/MAN
|
Facility
|
OP
|
$5,618.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
900501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,123.60
|
| 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 |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: Cigna of CA HMO |
$3,595.52
|
| Rate for Payer: Cigna of CA PPO |
$4,157.32
|
| 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 |
$4,775.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,370.80
|
| 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 |
$3,747.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.32
|
| 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 |
$4,494.40
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,651.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,775.30
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,809.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,809.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,809.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,809.00
|
| 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 TIBIA SHAFT FX W/MAN
|
Facility
|
IP
|
$5,618.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
900501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,123.60 |
| Max. Negotiated Rate |
$4,775.30 |
| Rate for Payer: Adventist Health Commercial |
$1,123.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,146.08
|
| Rate for Payer: Blue Shield of California EPN |
$2,730.35
|
| Rate for Payer: Cash Price |
$2,528.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,247.20
|
| Rate for Payer: Galaxy Health WC |
$4,775.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,747.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,140.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,477.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,348.32
|
| Rate for Payer: Multiplan Commercial |
$4,494.40
|
| Rate for Payer: Networks By Design Commercial |
$3,651.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,775.30
|
|
|
HC CL TREAT TOE DSLOCATN W/O ANES
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
900501409
|
|
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 TOE DSLOCATN W/O ANES
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
900501409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.72 |
| 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 |
$116.72
|
| 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 TOE FX WO MAN EA
|
Facility
|
OP
|
$1,416.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
900501489
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.69 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| 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 |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: Cigna of CA HMO |
$906.24
|
| Rate for Payer: Cigna of CA PPO |
$1,047.84
|
| 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 |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| 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 |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| 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 |
$1,132.80
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$708.00
|
| Rate for Payer: United Healthcare All Other HMO |
$708.00
|
| Rate for Payer: United Healthcare HMO Rider |
$708.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$708.00
|
| 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 TOE FX WO MAN EA
|
Facility
|
IP
|
$1,416.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
900501489
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.20 |
| Max. Negotiated Rate |
$1,203.60 |
| Rate for Payer: Adventist Health Commercial |
$283.20
|
| Rate for Payer: Cash Price |
$637.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$566.40
|
| Rate for Payer: Galaxy Health WC |
$1,203.60
|
| Rate for Payer: Global Benefits Group Commercial |
$849.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$944.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$876.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.84
|
| Rate for Payer: Multiplan Commercial |
$1,132.80
|
| Rate for Payer: Networks By Design Commercial |
$920.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,203.60
|
|
