|
HC CL TREAT FEMORAL FX W/ MANIPUL
|
Facility
|
IP
|
$10,416.00
|
|
|
Service Code
|
CPT 27232
|
| Hospital Charge Code |
900501442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,885.30 |
| Max. Negotiated Rate |
$7,812.00 |
| Rate for Payer: Adventist Health Commercial |
$2,083.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,707.90
|
| Rate for Payer: Cash Price |
$4,687.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,051.63
|
| Rate for Payer: Heritage Provider Network Senior |
$7,051.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,885.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,604.00
|
| Rate for Payer: Multiplan Commercial |
$7,812.00
|
|
|
HC CL TREAT FEMORAL FX, W MANIPUL
|
Facility
|
IP
|
$2,444.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
900501427
|
|
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: Aetna of CA Non-Gatekeeper |
$1,573.94
|
| Rate for Payer: Cash Price |
$1,099.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,654.59
|
| Rate for Payer: Heritage Provider Network Senior |
$1,654.59
|
| Rate for Payer: Kaiser Foundation Hospitals 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 FEMORAL FX, W MANIPUL
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 27510
|
| Hospital Charge Code |
900501427
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$488.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,510.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,160.90
|
| Rate for Payer: Blue Shield of California EPN |
$923.83
|
| Rate for Payer: Cash Price |
$1,099.80
|
| Rate for Payer: Cash Price |
$1,099.80
|
| Rate for Payer: Cash Price |
$1,099.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,588.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| 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) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,165.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$442.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$611.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,833.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,466.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,466.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CL TREAT FEMORAL FX, W/O MANIP
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
900501482
|
|
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: Aetna of CA Non-Gatekeeper |
$694.88
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$730.48
|
| Rate for Payer: Heritage Provider Network Senior |
$730.48
|
| Rate for Payer: Kaiser Foundation Hospitals 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 FEMORAL FX, W/O MANIP
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 27508
|
| Hospital Charge Code |
900501482
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$666.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$512.52
|
| Rate for Payer: Blue Shield of California EPN |
$407.86
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$701.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| 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) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$514.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$647.40
|
| Rate for Payer: TriValley Medical Group Senior |
$647.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT FEMORAL SHAFT FX,W/O
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
900501463
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.59 |
| Max. Negotiated Rate |
$955.50 |
| Rate for Payer: Adventist Health Commercial |
$254.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$820.46
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$862.50
|
| Rate for Payer: Heritage Provider Network Senior |
$862.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.50
|
| Rate for Payer: Multiplan Commercial |
$955.50
|
|
|
HC CL TREAT FEMORAL SHAFT FX,W/O
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 27500
|
| Hospital Charge Code |
900501463
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$254.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$787.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$605.15
|
| Rate for Payer: Blue Shield of California EPN |
$481.57
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$862.50
|
| Rate for Payer: Heritage Provider Network Senior |
$862.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$607.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$230.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$955.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$764.40
|
| Rate for Payer: TriValley Medical Group Senior |
$764.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT FEM SHAFT FRAC W/MANI
|
Facility
|
IP
|
$7,659.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
900501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,386.28 |
| Max. Negotiated Rate |
$5,744.25 |
| Rate for Payer: Adventist Health Commercial |
$1,531.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,932.40
|
| Rate for Payer: Cash Price |
$3,446.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,185.14
|
| Rate for Payer: Heritage Provider Network Senior |
$5,185.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,386.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.75
|
| Rate for Payer: Multiplan Commercial |
$5,744.25
|
|
|
HC CL TREAT FEM SHAFT FRAC W/MANI
|
Facility
|
OP
|
$7,659.00
|
|
|
Service Code
|
CPT 27502
|
| Hospital Charge Code |
900501085
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,386.28 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,531.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,733.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,895.10
|
| Rate for Payer: Cash Price |
$3,446.55
|
| Rate for Payer: Cash Price |
$3,446.55
|
| Rate for Payer: Cash Price |
$3,446.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,978.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,185.14
|
| Rate for Payer: Heritage Provider Network Senior |
$5,185.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,653.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,386.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,914.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$5,744.25
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,595.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,595.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CL TREAT FIBULA FX W/MANIPULAT
|
Facility
|
OP
|
$4,233.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
900501487
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,615.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,010.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,600.07
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,751.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,019.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$766.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,539.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,539.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CL TREAT FIBULA FX W/MANIPULAT
|
Facility
|
IP
|
$4,233.00
|
|
|
Service Code
|
CPT 27781
|
| Hospital Charge Code |
900501487
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$3,174.75 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,726.05
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$766.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.25
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
|
|
HC CL TREAT FIBULA/SHAFT FX W/O M
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
900501759
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$264.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$203.30
|
| Rate for Payer: Blue Shield of California EPN |
$161.78
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$278.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$204.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$256.80
|
| Rate for Payer: TriValley Medical Group Senior |
$256.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT FIBULA/SHAFT FX W/O M
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 27780
|
| Hospital Charge Code |
900501759
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.47 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Adventist Health Commercial |
$85.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$275.63
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$289.76
|
| Rate for Payer: Heritage Provider Network Senior |
$289.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Multiplan Commercial |
$321.00
|
|
|
HC CL TREAT FINGER/THUMB FX W/O M
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
900501393
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$666.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$512.52
|
| Rate for Payer: Blue Shield of California EPN |
$407.86
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$701.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| 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) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$514.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$647.40
|
| Rate for Payer: TriValley Medical Group Senior |
$647.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT FINGER/THUMB FX W/O M
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
900501393
|
|
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: Aetna of CA Non-Gatekeeper |
$694.88
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$730.48
|
| Rate for Payer: Heritage Provider Network Senior |
$730.48
|
| Rate for Payer: Kaiser Foundation Hospitals 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 FOOT DISLOCAT W/O ANE
|
Facility
|
IP
|
$511.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
900501655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.49 |
| Max. Negotiated Rate |
$383.25 |
| Rate for Payer: Adventist Health Commercial |
$102.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.08
|
| Rate for Payer: Cash Price |
$229.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.95
|
| Rate for Payer: Heritage Provider Network Senior |
$345.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.75
|
| Rate for Payer: Multiplan Commercial |
$383.25
|
|
|
HC CL TREAT FOOT DISLOCAT W/O ANE
|
Facility
|
OP
|
$511.00
|
|
|
Service Code
|
CPT 28600
|
| Hospital Charge Code |
900501655
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$92.49 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$102.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$315.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$242.72
|
| Rate for Payer: Blue Shield of California EPN |
$193.16
|
| Rate for Payer: Cash Price |
$229.95
|
| Rate for Payer: Cash Price |
$229.95
|
| Rate for Payer: Cash Price |
$229.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$332.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$345.95
|
| Rate for Payer: Heritage Provider Network Senior |
$345.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$243.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$92.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$383.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$306.60
|
| Rate for Payer: TriValley Medical Group Senior |
$306.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT FRAC OF WT BEAR W/SKE
|
Facility
|
IP
|
$4,598.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
900501095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$832.24 |
| Max. Negotiated Rate |
$3,448.50 |
| Rate for Payer: Adventist Health Commercial |
$919.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,961.11
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,112.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,112.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,149.50
|
| Rate for Payer: Multiplan Commercial |
$3,448.50
|
|
|
HC CL TREAT FRAC OF WT BEAR W/SKE
|
Facility
|
OP
|
$4,598.00
|
|
|
Service Code
|
CPT 27825
|
| Hospital Charge Code |
900501095
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$832.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$919.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,841.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,184.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,738.04
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cash Price |
$2,069.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,988.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,112.85
|
| Rate for Payer: Heritage Provider Network Senior |
$3,112.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,193.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$832.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,149.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$3,448.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,758.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,758.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CL TREAT FX OF WT BRNG LWR LEG
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
900501502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$681.00 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$584.75
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$614.72
|
| Rate for Payer: Heritage Provider Network Senior |
$614.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.00
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
|
|
HC CL TREAT FX OF WT BRNG LWR LEG
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
CPT 27824
|
| Hospital Charge Code |
900501502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$181.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$561.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$431.30
|
| Rate for Payer: Blue Shield of California EPN |
$343.22
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$590.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$317.26
|
| Rate for Payer: Heritage Provider Network Commercial |
$614.72
|
| Rate for Payer: Heritage Provider Network Senior |
$614.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$433.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$681.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$544.80
|
| Rate for Payer: TriValley Medical Group Senior |
$544.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TREAT FX ORBIT, W/O MANIPUL
|
Facility
|
IP
|
$2,002.00
|
|
|
Service Code
|
CPT 21400
|
| Hospital Charge Code |
900501526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$362.36 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Adventist Health Commercial |
$400.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,289.29
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,355.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,355.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.50
|
| Rate for Payer: Multiplan Commercial |
$1,501.50
|
|
|
HC CL TREAT FX ORBIT, W/O MANIPUL
|
Facility
|
OP
|
$2,002.00
|
|
|
Service Code
|
CPT 21400
|
| Hospital Charge Code |
900501526
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$362.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$400.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,237.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$950.95
|
| Rate for Payer: Blue Shield of California EPN |
$756.76
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cash Price |
$900.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,301.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,355.35
|
| Rate for Payer: Heritage Provider Network Senior |
$1,355.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$954.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$362.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$500.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,501.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,201.20
|
| Rate for Payer: TriValley Medical Group Senior |
$1,201.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC CL TREAT GRT HUMERUS FX W/MANI
|
Facility
|
OP
|
$4,233.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
900501414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,615.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,010.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,600.07
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,751.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,068.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,019.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$766.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,539.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,539.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
HC CL TREAT GRT HUMERUS FX W/MANI
|
Facility
|
IP
|
$4,233.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
900501414
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$766.17 |
| Max. Negotiated Rate |
$3,174.75 |
| Rate for Payer: Adventist Health Commercial |
$846.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,726.05
|
| Rate for Payer: Cash Price |
$1,904.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,865.74
|
| Rate for Payer: Heritage Provider Network Senior |
$2,865.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$766.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.25
|
| Rate for Payer: Multiplan Commercial |
$3,174.75
|
|
