|
HC CL TREAT KNEE FRACTURES
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 27538
|
| Hospital Charge Code |
900501533
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: Blue Shield of California Commercial |
$416.51
|
| Rate for Payer: Blue Shield of California EPN |
$396.77
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.20
|
| Rate for Payer: Heritage Provider Network Senior |
$668.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
|
|
HC CL TREAT LUNATE DISLOCA W/MANI
|
Facility
OP
|
$3,656.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
900501383
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$731.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,645.20
|
| Rate for Payer: Cash Price |
$1,645.20
|
| Rate for Payer: Cash Price |
$1,645.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,376.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,475.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,475.11
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,762.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$2,742.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,327.49
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,221.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC CL TREAT LUNATE DISLOCA W/MANI
|
Facility
IP
|
$3,656.00
|
|
|
Service Code
|
CPT 25690
|
| Hospital Charge Code |
900501383
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.74 |
| Max. Negotiated Rate |
$2,742.00 |
| Rate for Payer: Adventist Health Commercial |
$731.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,511.67
|
| Rate for Payer: Cash Price |
$1,645.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,475.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,475.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$914.00
|
| Rate for Payer: Multiplan Commercial |
$2,742.00
|
|
|
HC CL TREAT MANDIBULAR FX
|
Facility
IP
|
$9,575.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
900501369
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,733.08 |
| Max. Negotiated Rate |
$7,181.25 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
|
|
HC CL TREAT MANDIBULAR FX
|
Facility
OP
|
$9,575.00
|
|
|
Service Code
|
CPT 21453
|
| Hospital Charge Code |
900501369
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$10,975.35 |
| Rate for Payer: Adventist Health Commercial |
$1,915.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,578.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cash Price |
$4,308.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,223.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,482.28
|
| Rate for Payer: Heritage Provider Network Senior |
$6,482.28
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,615.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,393.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: Multiplan Commercial |
$7,181.25
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,476.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,199.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
IP
|
$3,544.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$641.46 |
| Max. Negotiated Rate |
$2,658.00 |
| Rate for Payer: Adventist Health Commercial |
$708.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,434.73
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,399.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,399.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$886.00
|
| Rate for Payer: Multiplan Commercial |
$2,658.00
|
|
|
HC CL TREAT MANDIBULAR FX W/MANIP
|
Facility
OP
|
$3,544.00
|
|
|
Service Code
|
CPT 21451
|
| Hospital Charge Code |
900501420
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$641.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$708.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,434.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cash Price |
$1,594.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,303.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: Dignity Health Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,905.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,399.29
|
| Rate for Payer: Heritage Provider Network Senior |
$2,399.29
|
| Rate for Payer: Humana Medicare |
$1,905.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,708.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$641.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,248.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$886.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,400.85
|
| Rate for Payer: Multiplan Commercial |
$2,658.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,286.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
IP
|
$8,326.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,507.01 |
| Max. Negotiated Rate |
$6,244.50 |
| Rate for Payer: Adventist Health Commercial |
$1,665.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,719.96
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,636.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,636.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.50
|
| Rate for Payer: Multiplan Commercial |
$6,244.50
|
|
|
HC CL TREAT MANDIBULAR RIDGE FRAC
|
Facility
OP
|
$8,326.00
|
|
|
Service Code
|
CPT 21440
|
| Hospital Charge Code |
900501330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,665.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,719.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cash Price |
$3,746.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,411.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,636.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,636.70
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,013.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,507.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,081.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$6,244.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,023.17
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,781.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
IP
|
$4,208.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$761.65 |
| Max. Negotiated Rate |
$3,156.00 |
| Rate for Payer: Adventist Health Commercial |
$841.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,890.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,775.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,691.62
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,848.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,848.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,052.00
|
| Rate for Payer: Multiplan Commercial |
$3,156.00
|
|
|
HC CL TREAT MED MALL FX W/MANIPUL
|
Facility
OP
|
$4,208.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
900501091
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$761.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$841.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,890.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cash Price |
$1,893.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,735.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,848.82
|
| Rate for Payer: Heritage Provider Network Senior |
$2,848.82
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,028.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,052.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$3,156.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,527.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,405.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC CL TREAT METACARPAL FX, SNGL
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.20
|
| Rate for Payer: Heritage Provider Network Senior |
$668.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
|
|
HC CL TREAT METACARPAL FX, SNGL
|
Facility
OP
|
$987.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
900501386
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$541.70
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$641.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.20
|
| Rate for Payer: Heritage Provider Network Senior |
$668.20
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$329.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT METACARPAL W/MANIPULA
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.20
|
| Rate for Payer: Heritage Provider Network Senior |
$668.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
|
|
HC CL TREAT METACARPAL W/MANIPULA
|
Facility
OP
|
$987.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
900501340
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$590.56
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$641.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.20
|
| Rate for Payer: Heritage Provider Network Senior |
$668.20
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$329.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT META FX SNGL W/MAN
|
Facility
IP
|
$1,173.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.31 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.12
|
| Rate for Payer: Heritage Provider Network Senior |
$794.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
|
|
HC CL TREAT META FX SNGL W/MAN
|
Facility
OP
|
$1,173.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
900501076
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$805.85
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cash Price |
$527.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$762.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$794.12
|
| Rate for Payer: Heritage Provider Network Senior |
$794.12
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$565.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$425.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$391.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT META FX W/EXT FIX EA
|
Facility
OP
|
$3,875.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$701.38 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$775.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,662.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,743.75
|
| Rate for Payer: Cash Price |
$1,743.75
|
| Rate for Payer: Cash Price |
$1,743.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,518.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,623.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,623.38
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,867.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$2,906.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,407.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,294.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC CL TREAT META FX W/EXT FIX EA
|
Facility
IP
|
$3,875.00
|
|
|
Service Code
|
CPT 26607
|
| Hospital Charge Code |
900501717
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$701.38 |
| Max. Negotiated Rate |
$2,906.25 |
| Rate for Payer: Adventist Health Commercial |
$775.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,662.12
|
| Rate for Payer: Cash Price |
$1,743.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,623.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,623.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.75
|
| Rate for Payer: Multiplan Commercial |
$2,906.25
|
|
|
HC CL TREAT MOUTH ROOF FX
|
Facility
IP
|
$15,171.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,745.95 |
| Max. Negotiated Rate |
$11,378.25 |
| Rate for Payer: Adventist Health Commercial |
$3,034.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,422.48
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,270.77
|
| Rate for Payer: Heritage Provider Network Senior |
$10,270.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,745.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,792.75
|
| Rate for Payer: Multiplan Commercial |
$11,378.25
|
|
|
HC CL TREAT MOUTH ROOF FX
|
Facility
OP
|
$15,171.00
|
|
|
Service Code
|
CPT 21421
|
| Hospital Charge Code |
900501741
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$11,378.25 |
| Rate for Payer: Adventist Health Commercial |
$3,034.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,422.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,861.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,270.77
|
| Rate for Payer: Heritage Provider Network Senior |
$10,270.77
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,312.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,745.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,792.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$11,378.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,508.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,068.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC CL TREAT NASAL SEPTAL FX
|
Facility
OP
|
$3,556.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.64 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,442.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,311.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: Dignity Health Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,022.69
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,407.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,407.41
|
| Rate for Payer: Humana Medicare |
$4,022.69
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,713.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,746.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,068.59
|
| Rate for Payer: Multiplan Commercial |
$2,667.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,291.18
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,188.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC CL TREAT NASAL SEPTAL FX
|
Facility
IP
|
$3,556.00
|
|
|
Service Code
|
CPT 21337
|
| Hospital Charge Code |
900501499
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$643.64 |
| Max. Negotiated Rate |
$2,667.00 |
| Rate for Payer: Adventist Health Commercial |
$711.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,442.97
|
| Rate for Payer: Cash Price |
$1,600.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,407.41
|
| Rate for Payer: Heritage Provider Network Senior |
$2,407.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$889.00
|
| Rate for Payer: Multiplan Commercial |
$2,667.00
|
|
|
HC CL TREAT OF ACROMICLAV W/MANIP
|
Facility
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$1,099.50 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,007.14
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
|
|
HC CL TREAT OF ACROMICLAV W/MANIP
|
Facility
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 23545
|
| Hospital Charge Code |
900501358
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,007.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$952.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$706.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$532.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$489.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
