|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
IP
|
$524.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$94.84 |
| Max. Negotiated Rate |
$393.00 |
| Rate for Payer: Adventist Health Commercial |
$104.80
|
| Rate for Payer: Cash Price |
$288.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.75
|
| Rate for Payer: Heritage Provider Network Senior |
$354.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.00
|
| Rate for Payer: Multiplan Commercial |
$393.00
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
OP
|
$524.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$104.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$359.99
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$288.20
|
| Rate for Payer: Cash Price |
$288.20
|
| Rate for Payer: Cash Price |
$288.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$340.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Senior |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.75
|
| Rate for Payer: Heritage Provider Network Senior |
$354.75
|
| 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 |
$249.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.04
|
| Rate for Payer: Multiplan Commercial |
$393.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$188.54
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$173.50
|
| 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 CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$781.50 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$573.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$705.43
|
| Rate for Payer: Heritage Provider Network Senior |
$705.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.50
|
| Rate for Payer: Multiplan Commercial |
$781.50
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$715.85
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$573.10
|
| Rate for Payer: Cash Price |
$573.10
|
| Rate for Payer: Cash Price |
$573.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$677.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Senior |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$705.43
|
| Rate for Payer: Heritage Provider Network Senior |
$705.43
|
| 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 |
$497.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.04
|
| Rate for Payer: Multiplan Commercial |
$781.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$374.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$345.01
|
| 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 CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Cash Price |
$235.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$294.04
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$235.40
|
| Rate for Payer: Cash Price |
$235.40
|
| Rate for Payer: Cash Price |
$235.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$278.20
|
| 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 Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| 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 |
$204.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$153.99
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$141.71
|
| 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 CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$51.31
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$65.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.05
|
| Rate for Payer: Blue Shield of California Commercial |
$74.76
|
| Rate for Payer: Blue Shield of California EPN |
$59.97
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$62.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$59.42
|
| Rate for Payer: Heritage Provider Network Senior |
$59.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.99
|
| Rate for Payer: Heritage Provider Network Senior |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
OP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$13,240.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$485.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$406.82
|
| Rate for Payer: Blue Shield of California EPN |
$406.82
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$465.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Senior |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$647.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.56
|
| Rate for Payer: Heritage Provider Network Senior |
$468.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$365.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
|
IP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$13,277.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$485.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,277.00
|
| Rate for Payer: Blue Shield of California Commercial |
$406.82
|
| Rate for Payer: Blue Shield of California EPN |
$406.82
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$465.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.56
|
| Rate for Payer: Heritage Provider Network Senior |
$468.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$365.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$335.07
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$289.96 |
| Max. Negotiated Rate |
$1,201.50 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,084.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,084.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.50
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$320.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,100.57
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cash Price |
$881.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,041.30
|
| 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 Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,084.55
|
| Rate for Payer: Heritage Provider Network Senior |
$1,084.55
|
| 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 |
$764.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$400.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$1,201.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$576.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$530.42
|
| 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 CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
OP
|
$1,067.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$733.03
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$693.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Senior |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$722.36
|
| Rate for Payer: Heritage Provider Network Senior |
$722.36
|
| 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 |
$508.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.04
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$383.91
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$353.28
|
| 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 CLSD TX PST MALLS FRC WO MANIP
|
Facility
|
IP
|
$1,067.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$193.13 |
| Max. Negotiated Rate |
$800.25 |
| Rate for Payer: Adventist Health Commercial |
$213.40
|
| Rate for Payer: Cash Price |
$586.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$722.36
|
| Rate for Payer: Heritage Provider Network Senior |
$722.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.75
|
| Rate for Payer: Multiplan Commercial |
$800.25
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
|
OP
|
$13,630.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$11,585.50 |
| Rate for Payer: Adventist Health Commercial |
$2,726.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,285.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,363.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,496.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,222.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,859.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,585.50
|
| Rate for Payer: Dignity Health Senior |
$11,585.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,436.97
|
| Rate for Payer: Heritage Provider Network Senior |
$8,436.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$972.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,501.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,467.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,407.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,541.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.00
|
| Rate for Payer: Multiplan Commercial |
$10,222.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,585.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,585.50
|
| Rate for Payer: Vantage Medical Group Senior |
$11,585.50
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
|
IP
|
$13,630.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,467.03 |
| Max. Negotiated Rate |
$10,222.50 |
| Rate for Payer: Adventist Health Commercial |
$2,726.00
|
| Rate for Payer: Cash Price |
$7,496.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,227.51
|
| Rate for Payer: Heritage Provider Network Senior |
$9,227.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,467.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,407.50
|
| Rate for Payer: Multiplan Commercial |
$10,222.50
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
|
OP
|
$1,556.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$311.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,068.97
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,011.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Senior |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,053.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,053.41
|
| 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 |
$742.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.04
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$559.85
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$515.19
|
| 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/ACROMIOCLAVICULAR DIS
|
Facility
|
IP
|
$1,556.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.64 |
| Max. Negotiated Rate |
$1,167.00 |
| Rate for Payer: Adventist Health Commercial |
$311.20
|
| Rate for Payer: Cash Price |
$855.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,053.41
|
| Rate for Payer: Heritage Provider Network Senior |
$1,053.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$389.00
|
| Rate for Payer: Multiplan Commercial |
$1,167.00
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
|
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$227.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$780.43
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cash Price |
$624.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$738.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Senior |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$769.07
|
| Rate for Payer: Heritage Provider Network Senior |
$769.07
|
| 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 |
$541.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.04
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$408.73
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$376.13
|
| 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 ANKLE DISCLOC W/ANES
|
Facility
|
OP
|
$3,682.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$736.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,529.53
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,393.30
|
| 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 Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,492.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,492.71
|
| 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 |
$1,756.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$2,761.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,324.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,219.11
|
| 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 ANKLE DISCLOC W/ANES
|
Facility
|
IP
|
$3,682.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$666.44 |
| Max. Negotiated Rate |
$2,761.50 |
| Rate for Payer: Adventist Health Commercial |
$736.40
|
| Rate for Payer: Cash Price |
$2,025.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,492.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,492.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$666.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.50
|
| Rate for Payer: Multiplan Commercial |
$2,761.50
|
|
|
HC CL TREAT ANKLE MM FX W/O MANIP
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
900501371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$593.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$730.48
|
| Rate for Payer: Heritage Provider Network Senior |
$730.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.75
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
|
