|
HC CL TREAT FX ORBIT, W/O MANIPUL
|
Facility
|
IP
|
$2,002.00
|
|
|
Service Code
|
CPT 21400
|
| Hospital Charge Code |
900501526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$362.36 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Adventist Health Commercial |
$400.40
|
| Rate for Payer: Cash Price |
$1,101.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,355.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,355.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.50
|
| Rate for Payer: Multiplan Commercial |
$1,501.50
|
|
|
HC CL TREAT GRT HUMERUS FX W/MANI
|
Facility
|
IP
|
$4,233.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
900501414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$3,174.75 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Cash Price |
$2,328.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$766.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.25
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
|
|
HC CL TREAT GRT HUMERUS FX W/MANI
|
Facility
|
OP
|
$4,233.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
900501414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,908.07
|
| 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 |
$2,328.15
|
| Rate for Payer: Cash Price |
$2,328.15
|
| Rate for Payer: Cash Price |
$2,328.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,751.45
|
| 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 |
$2,865.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.74
|
| 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 |
$2,019.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$766.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.25
|
| 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 |
$3,174.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,523.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,401.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC CL TREAT GRT HUMERUS FX W/O MA
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
900501476
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$741.27
|
| 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 |
$593.45
|
| Rate for Payer: Cash Price |
$593.45
|
| Rate for Payer: Cash Price |
$593.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$701.35
|
| 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 |
$730.48
|
| Rate for Payer: Heritage Provider Network Senior |
$730.48
|
| 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 |
$514.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.75
|
| 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 |
$809.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$388.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$357.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT GRT HUMERUS FX W/O MA
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 23620
|
| Hospital Charge Code |
900501476
|
|
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
|
|
|
HC CL TREAT GRT TOE FRAC W/O MANI
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
900501327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$457.54
|
| 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 |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$432.90
|
| 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 |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| 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 |
$317.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| 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 |
$499.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$239.63
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$220.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT GRT TOE FRAC W/O MANI
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
900501327
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
|
HC CL TREAT HAND DSLOCATN W/MANIP
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 26670
|
| Hospital Charge Code |
900501506
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$207.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$553.74
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$711.73
|
| 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 |
$569.80
|
| Rate for Payer: Cash Price |
$569.80
|
| Rate for Payer: Cash Price |
$569.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$673.40
|
| 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 |
$701.37
|
| Rate for Payer: Heritage Provider Network Senior |
$701.37
|
| 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 |
$494.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| 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 |
$777.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$372.75
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$343.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
HC CL TREAT HAND DSLOCATN W/MANIP
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 26670
|
| Hospital Charge Code |
900501506
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.52 |
| Max. Negotiated Rate |
$777.00 |
| Rate for Payer: Adventist Health Commercial |
$207.20
|
| Rate for Payer: Cash Price |
$569.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$701.37
|
| Rate for Payer: Heritage Provider Network Senior |
$701.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.00
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
|
|
HC CL TREAT HIP DISC TR W/ANESTH
|
Facility
|
OP
|
$5,818.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
900501083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,163.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,996.97
|
| 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 |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,199.90
|
| Rate for Payer: Cash Price |
$3,199.90
|
| Rate for Payer: Cash Price |
$3,199.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,781.70
|
| 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 |
$3,938.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,938.79
|
| 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 |
$2,775.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,053.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,454.50
|
| 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 |
$4,363.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,093.32
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,926.34
|
| 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 HIP DISC TR W/ANESTH
|
Facility
|
IP
|
$5,818.00
|
|
|
Service Code
|
CPT 27252
|
| Hospital Charge Code |
900501083
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,053.06 |
| Max. Negotiated Rate |
$4,363.50 |
| Rate for Payer: Adventist Health Commercial |
$1,163.60
|
| Rate for Payer: Cash Price |
$3,199.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,938.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,938.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,053.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,454.50
|
| Rate for Payer: Multiplan Commercial |
$4,363.50
|
|
|
HC CL TREAT HIP DISC TR W/O ANEST
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
900501228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.70
|
| 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 |
$469.70
|
| Rate for Payer: Cash Price |
$469.70
|
| Rate for Payer: Cash Price |
$469.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$555.10
|
| 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 |
$578.16
|
| Rate for Payer: Heritage Provider Network Senior |
$578.16
|
| 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 |
$407.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| 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 |
$640.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$307.27
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$282.76
|
| 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 HIP DISC TR W/O ANEST
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
900501228
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.57 |
| Max. Negotiated Rate |
$640.50 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Cash Price |
$469.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$578.16
|
| Rate for Payer: Heritage Provider Network Senior |
$578.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
|
|
HC CL TREAT HUMERAL FRAC W/O MANI
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
900501326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
|
|
HC CL TREAT HUMERAL FRAC W/O MANI
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 24530
|
| Hospital Charge Code |
900501326
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.86
|
| 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 |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$592.15
|
| 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 |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| 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 |
$434.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| 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 |
$683.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$327.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$301.63
|
| 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 HUMERAL FX W/MANIPULA
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
900501497
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
|
|
HC CL TREAT HUMERAL FX W/MANIPULA
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 24565
|
| Hospital Charge Code |
900501497
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$625.86
|
| 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 |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$592.15
|
| 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 |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| 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 |
$434.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| 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 |
$683.25
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$327.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$301.63
|
| 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 HUMERAL SHAFT FX W/O
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
900501520
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$741.27
|
| 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 |
$593.45
|
| Rate for Payer: Cash Price |
$593.45
|
| Rate for Payer: Cash Price |
$593.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$701.35
|
| 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 |
$730.48
|
| Rate for Payer: Heritage Provider Network Senior |
$730.48
|
| 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 |
$514.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.75
|
| 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 |
$809.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$388.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$357.26
|
| 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 HUMERAL SHAFT FX W/O
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
900501520
|
|
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
|
|
|
HC CL TREAT HUMERUS FX W/MANIPULA
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
900501365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.65 |
| Max. Negotiated Rate |
$906.00 |
| Rate for Payer: Adventist Health Commercial |
$241.60
|
| Rate for Payer: Cash Price |
$664.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.82
|
| Rate for Payer: Heritage Provider Network Senior |
$817.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.00
|
| Rate for Payer: Multiplan Commercial |
$906.00
|
|
|
HC CL TREAT HUMERUS FX W/MANIPULA
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
CPT 24577
|
| Hospital Charge Code |
900501365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$241.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$829.90
|
| 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 |
$664.40
|
| Rate for Payer: Cash Price |
$664.40
|
| Rate for Payer: Cash Price |
$664.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$785.20
|
| 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 |
$817.82
|
| Rate for Payer: Heritage Provider Network Senior |
$817.82
|
| 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 |
$576.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.00
|
| 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 |
$906.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$434.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$399.97
|
| 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 HUMERUS FX W/O MANIPU
|
Facility
|
OP
|
$950.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
900501566
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$652.65
|
| 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 |
$522.50
|
| Rate for Payer: Cash Price |
$522.50
|
| Rate for Payer: Cash Price |
$522.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$617.50
|
| 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 |
$643.15
|
| Rate for Payer: Heritage Provider Network Senior |
$643.15
|
| 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 |
$453.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| 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 |
$712.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$341.81
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$314.55
|
| 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 HUMERUS FX W/O MANIPU
|
Facility
|
IP
|
$950.00
|
|
|
Service Code
|
CPT 24576
|
| Hospital Charge Code |
900501566
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.95 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Adventist Health Commercial |
$190.00
|
| Rate for Payer: Cash Price |
$522.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.15
|
| Rate for Payer: Heritage Provider Network Senior |
$643.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$237.50
|
| Rate for Payer: Multiplan Commercial |
$712.50
|
|
|
HC CL TREAT INTPHAL JOINT SIN W/A
|
Facility
|
OP
|
$1,595.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
900501080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.69 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$319.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$852.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,095.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,036.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Senior |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$337.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,079.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,079.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$760.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$388.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$425.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.19
|
| Rate for Payer: Multiplan Commercial |
$1,196.25
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$573.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$528.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC CL TREAT INTPHAL JOINT SIN W/A
|
Facility
|
IP
|
$1,595.00
|
|
|
Service Code
|
CPT 26775
|
| Hospital Charge Code |
900501080
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.69 |
| Max. Negotiated Rate |
$1,196.25 |
| Rate for Payer: Adventist Health Commercial |
$319.00
|
| Rate for Payer: Cash Price |
$877.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,079.82
|
| Rate for Payer: Heritage Provider Network Senior |
$1,079.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$398.75
|
| Rate for Payer: Multiplan Commercial |
$1,196.25
|
|
