|
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 |
$2,353.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3,569.70
|
| Rate for Payer: Cash Price |
$2,088.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,249.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,947.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,738.78
|
| 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 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,758.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| 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/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,409.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$797.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| 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 |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
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 |
$2,722.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.76
|
| Rate for Payer: Cash Price |
$2,416.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,758.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,409.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,167.71
|
| 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
|
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 |
$284.93
|
| Rate for Payer: Blue Shield of California Commercial |
$432.18
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$393.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$356.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$331.58
|
| 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 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 |
$5,641.00 |
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Adventist Health Commercial |
$112.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$393.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$868.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$806.53
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$868.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$806.53
|
| 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
|
456
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$560.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,140.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| 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/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$868.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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: TriValley Medical Group Commercial/Senior |
$820.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Adventist Health Commercial |
$273.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$956.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| 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/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$868.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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 |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$549.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$498.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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 |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$549.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$498.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$463.15
|
| 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 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$936.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,276.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| 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/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,972.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,123.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| 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 |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,276.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,972.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,761.79
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$587.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$532.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$495.01
|
| 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 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$587.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$532.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$360.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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 |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,867.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,735.19
|
| 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 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 |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Adventist Health Commercial |
$588.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$1,040.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,058.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| 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/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,867.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$705.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| 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 |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| 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/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,587.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| 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 |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,955.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,587.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,333.50
|
| 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
|
IP
|
$5,650.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
900501414
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,955.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,587.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,333.50
|
| 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
|
456
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Galaxy Health WC |
$4,802.50
|
| Rate for Payer: Adventist Health Commercial |
$2,316.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,242.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Global Benefits Group Commercial |
$3,390.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,587.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,356.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| 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: TriValley Medical Group Commercial/Senior |
$3,390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,195.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,084.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,007.72
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$341.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| 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/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,084.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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 |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Galaxy Health WC |
$867.00
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: Global Benefits Group Commercial |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$647.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| 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 |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$714.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$647.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$601.80
|
| 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
|
|
