|
HC CL TREAT OF CARPOMETACARPAL
|
Facility
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$233.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.04
|
| 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 |
$524.70
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$757.90
|
| 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 |
$789.38
|
| Rate for Payer: Heritage Provider Network Senior |
$789.38
|
| 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 |
$562.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.50
|
| 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 |
$874.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$423.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$389.56
|
| 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 OF CARPOMETACARPAL
|
Facility
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 26645
|
| Hospital Charge Code |
900501286
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$874.50 |
| Rate for Payer: Adventist Health Commercial |
$233.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.04
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$789.38
|
| Rate for Payer: Heritage Provider Network Senior |
$789.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.50
|
| Rate for Payer: Multiplan Commercial |
$874.50
|
|
|
HC CL TREAT OF CLAV FRAC W/MANIPU
|
Facility
OP
|
$3,875.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
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 |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,662.12
|
| 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 |
$1,743.75
|
| 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 |
$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 |
$2,623.38
|
| Rate for Payer: Heritage Provider Network Senior |
$2,623.38
|
| 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 |
$1,867.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$968.75
|
| 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 |
$2,906.25
|
| 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 |
$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 OF CLAV FRAC W/MANIPU
|
Facility
IP
|
$3,875.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
900501357
|
|
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 OF CLAV FRAC W/O MANI
|
Facility
OP
|
$987.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
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 |
$1,335.00
|
| 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 OF CLAV FRAC W/O MANI
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 23500
|
| Hospital Charge Code |
900501058
|
|
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 OF DIS RAD FRAC W/MAN
|
Facility
IP
|
$1,893.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.63 |
| Max. Negotiated Rate |
$1,419.75 |
| Rate for Payer: Adventist Health Commercial |
$378.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,300.49
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,281.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,281.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.25
|
| Rate for Payer: Multiplan Commercial |
$1,419.75
|
|
|
HC CL TREAT OF DIS RAD FRAC W/MAN
|
Facility
OP
|
$1,893.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
900501071
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$342.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$378.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,300.49
|
| 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 |
$4,547.00
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cash Price |
$851.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,230.45
|
| 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 |
$1,281.56
|
| Rate for Payer: Heritage Provider Network Senior |
$1,281.56
|
| 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 |
$912.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$473.25
|
| 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 |
$1,419.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$687.35
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$632.45
|
| 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 OF DIS RAD FX W/O MAN
|
Facility
OP
|
$987.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
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 |
$1,335.00
|
| 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 |
$4,547.00
|
| 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 OF DIS RAD FX W/O MAN
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
900501070
|
|
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 OF ELB DISLOC W/ANEST
|
Facility
IP
|
$3,370.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.97 |
| Max. Negotiated Rate |
$2,527.50 |
| Rate for Payer: Adventist Health Commercial |
$674.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,315.19
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,281.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,281.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.50
|
| Rate for Payer: Multiplan Commercial |
$2,527.50
|
|
|
HC CL TREAT OF ELB DISLOC W/ANEST
|
Facility
OP
|
$3,370.00
|
|
|
Service Code
|
CPT 24605
|
| Hospital Charge Code |
900501064
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$674.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,315.19
|
| 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 |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,190.50
|
| 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 |
$2,281.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,281.49
|
| 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 |
$1,624.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.50
|
| 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 |
$2,527.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,223.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,125.92
|
| 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 OF ELBOW FRAC W/MANIP
|
Facility
IP
|
$3,656.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
900501359
|
|
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 OF ELBOW FRAC W/MANIP
|
Facility
OP
|
$3,656.00
|
|
|
Service Code
|
CPT 24620
|
| Hospital Charge Code |
900501359
|
|
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 |
$2,869.00
|
| 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 |
$4,547.00
|
| 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 OF FRAC OF PHAL W/MAN
|
Facility
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
900501099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$241.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$829.21
|
| 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 |
$543.15
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$784.55
|
| 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 |
$817.14
|
| Rate for Payer: Heritage Provider Network Senior |
$817.14
|
| 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 |
$581.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.75
|
| 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 |
$905.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$438.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$403.26
|
| 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 OF FRAC OF PHAL W/MAN
|
Facility
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
900501099
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$218.47 |
| Max. Negotiated Rate |
$905.25 |
| Rate for Payer: Adventist Health Commercial |
$241.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$829.21
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.14
|
| Rate for Payer: Heritage Provider Network Senior |
$817.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.75
|
| Rate for Payer: Multiplan Commercial |
$905.25
|
|
|
HC CL TREAT OF HEAD/NECK W/MANIPU
|
Facility
OP
|
$1,166.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$233.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.04
|
| 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 |
$524.70
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$757.90
|
| 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 |
$789.38
|
| Rate for Payer: Heritage Provider Network Senior |
$789.38
|
| 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 |
$562.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.50
|
| 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 |
$874.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$423.37
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$389.56
|
| 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 OF HEAD/NECK W/MANIPU
|
Facility
IP
|
$1,166.00
|
|
|
Service Code
|
CPT 24655
|
| Hospital Charge Code |
900501257
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$211.05 |
| Max. Negotiated Rate |
$874.50 |
| Rate for Payer: Adventist Health Commercial |
$233.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.04
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$789.38
|
| Rate for Payer: Heritage Provider Network Senior |
$789.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.50
|
| Rate for Payer: Multiplan Commercial |
$874.50
|
|
|
HC CL TREAT OF HUM SHAFT FRAC
|
Facility
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.35
|
| 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 |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$682.50
|
| 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 |
$710.85
|
| Rate for Payer: Heritage Provider Network Senior |
$710.85
|
| 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 |
$506.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.50
|
| 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 |
$787.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$381.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$350.80
|
| 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 OF HUM SHAFT FRAC
|
Facility
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
900501062
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$190.05 |
| Max. Negotiated Rate |
$787.50 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$721.35
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$710.85
|
| Rate for Payer: Heritage Provider Network Senior |
$710.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
|
|
HC CL TREAT OF INTPHAL JOINT SIN
|
Facility
OP
|
$987.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
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 |
$496.16
|
| 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 OF INTPHAL JOINT SIN
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
900501079
|
|
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 OF INTRPHAL JONT DISL
|
Facility
OP
|
$987.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
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 |
$1,335.00
|
| 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 OF INTRPHAL JONT DISL
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
900501258
|
|
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 OF KNEE DISC W/ANESTH
|
Facility
IP
|
$4,638.00
|
|
|
Service Code
|
CPT 27552
|
| Hospital Charge Code |
900501087
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$839.48 |
| Max. Negotiated Rate |
$3,478.50 |
| Rate for Payer: Adventist Health Commercial |
$927.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,186.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,957.24
|
| Rate for Payer: Blue Shield of California EPN |
$1,864.48
|
| Rate for Payer: Cash Price |
$2,087.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,139.93
|
| Rate for Payer: Heritage Provider Network Senior |
$3,139.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.50
|
| Rate for Payer: Multiplan Commercial |
$3,478.50
|
|
