|
HC CL TREAT OF TIB SHFT FRAC W/WO
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
900501233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$774.49
|
| Rate for Payer: Heritage Provider Network Senior |
$774.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$858.00
|
|
|
HC CL TREAT OF TM DIS INT OR SUBQ
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$692.25 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.87
|
| Rate for Payer: Heritage Provider Network Senior |
$624.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.75
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
|
|
HC CL TREAT OF TM DIS INT OR SUBQ
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$634.10
|
| 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 |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cash Price |
$507.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$599.95
|
| 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 |
$624.87
|
| Rate for Payer: Heritage Provider Network Senior |
$624.87
|
| 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 |
$440.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.75
|
| 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 |
$692.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$332.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$305.61
|
| 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 OF ULN SHAFT FRAC W/O
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
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 OF ULN SHAFT FRAC W/O
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
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 OF WRIST DISLOCATION
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
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 OF WRIST DISLOCATION
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
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 PHAL SHFT FX W/MANI
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,157.60
|
| 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 |
$926.75
|
| Rate for Payer: Cash Price |
$926.75
|
| Rate for Payer: Cash Price |
$926.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,095.25
|
| 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 |
$1,140.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,140.74
|
| 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 |
$803.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.25
|
| 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 |
$1,263.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$606.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$557.90
|
| 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 PHAL SHFT FX W/MANI
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.99 |
| Max. Negotiated Rate |
$1,263.75 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| Rate for Payer: Cash Price |
$926.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,140.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,140.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.25
|
| Rate for Payer: Multiplan Commercial |
$1,263.75
|
|
|
HC CL TREAT POST HIP ARTHOPLAS
|
Facility
|
IP
|
$3,973.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
900501084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$719.11 |
| Max. Negotiated Rate |
$2,979.75 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Cash Price |
$2,185.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,689.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,689.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.25
|
| Rate for Payer: Multiplan Commercial |
$2,979.75
|
|
|
HC CL TREAT POST HIP ARTHOPLAS
|
Facility
|
OP
|
$3,973.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
900501084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,729.45
|
| 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 |
$2,185.15
|
| Rate for Payer: Cash Price |
$2,185.15
|
| Rate for Payer: Cash Price |
$2,185.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,582.45
|
| 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 |
$2,689.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,689.72
|
| 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 |
$1,895.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.25
|
| 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 |
$2,979.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,429.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,315.46
|
| 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 POST HIP ARTH W/O ANE
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$774.49
|
| Rate for Payer: Heritage Provider Network Senior |
$774.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$858.00
|
|
|
HC CL TREAT POST HIP ARTH W/O ANE
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$785.93
|
| 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 |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cash Price |
$629.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$743.60
|
| 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 |
$774.49
|
| Rate for Payer: Heritage Provider Network Senior |
$774.49
|
| 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 |
$545.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$207.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| 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 |
$858.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$411.61
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$378.78
|
| 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 PROXIMAL HUMERAL FX
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
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 PROXIMAL HUMERAL FX
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
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 RADIAL HEAD/NECK FX
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
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 RADIAL HEAD/NECK FX
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
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 RADIAL SHAFT FRX W/DI
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$488.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,679.03
|
| 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 |
$1,344.20
|
| Rate for Payer: Cash Price |
$1,344.20
|
| Rate for Payer: Cash Price |
$1,344.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,588.60
|
| 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 |
$1,654.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,654.59
|
| 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 |
$1,165.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.00
|
| 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 |
$1,833.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$879.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$809.21
|
| 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 RADIAL SHAFT FRX W/DI
|
Facility
|
IP
|
$2,444.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.36 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$488.80
|
| Rate for Payer: Cash Price |
$1,344.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,654.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,654.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.00
|
| Rate for Payer: Multiplan Commercial |
$1,833.00
|
|
|
HC CL TREAT RADIAL SHAFT FX W/O M
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
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 RADIAL SHAFT FX W/O M
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
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 RADIOULNAR DIS W/MANI
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$750.20
|
| 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 |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$709.80
|
| 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 |
$739.28
|
| Rate for Payer: Heritage Provider Network Senior |
$739.28
|
| 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 |
$520.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.00
|
| 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 |
$819.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$392.90
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$361.56
|
| 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 RADIOULNAR DIS W/MANI
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Cash Price |
$600.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$739.28
|
| Rate for Payer: Heritage Provider Network Senior |
$739.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
|
|
HC CL TREAT RADIUS/ULNA FX,W/O MA
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
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 |
$4,959.00
|
| 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 RADIUS/ULNA FX,W/O MA
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
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
|
|
