|
HC CL TREAT OF META FRAC SIN W/O
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26500
|
| Hospital Charge Code |
900501075
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.56
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$844.28
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$887.55
|
| Rate for Payer: Heritage Provider Network Senior |
$887.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
|
|
HC CL TREAT OF MET FRAC W/O MANIP
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
CPT 28470
|
| Hospital Charge Code |
900501098
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$810.20
|
| 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 |
$622.73
|
| Rate for Payer: Blue Shield of California EPN |
$495.56
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Cash Price |
$589.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$852.15
|
| 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 |
$887.55
|
| Rate for Payer: Heritage Provider Network Senior |
$887.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$625.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$786.60
|
| Rate for Payer: TriValley Medical Group Senior |
$786.60
|
| 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 OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
OP
|
$3,680.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$666.08 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$736.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,274.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,748.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.04
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,392.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,995.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,491.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,755.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$666.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,294.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,760.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,208.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,208.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP WO STBLZTN
|
Facility
|
IP
|
$3,680.00
|
|
|
Service Code
|
CPT 21315
|
| Hospital Charge Code |
900501056
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$666.08 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Adventist Health Commercial |
$736.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,369.92
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,491.36
|
| Rate for Payer: Heritage Provider Network Senior |
$2,491.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$666.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.00
|
| Rate for Payer: Multiplan Commercial |
$2,760.00
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
|
OP
|
$3,885.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.18 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,400.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,845.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,468.53
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,525.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,264.23
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,853.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,903.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,331.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,331.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC CL TREAT OF NAS BONE FX W/MNP W/STBLZTN
|
Facility
|
IP
|
$3,885.00
|
|
|
Service Code
|
CPT 21320
|
| Hospital Charge Code |
900501405
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.18 |
| Max. Negotiated Rate |
$2,913.75 |
| Rate for Payer: Adventist Health Commercial |
$777.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,501.94
|
| Rate for Payer: Cash Price |
$1,748.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,630.14
|
| Rate for Payer: Heritage Provider Network Senior |
$2,630.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.25
|
| Rate for Payer: Multiplan Commercial |
$2,913.75
|
|
|
HC CL TREAT OF PAT DISC W/ANESTH
|
Facility
|
OP
|
$3,640.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,249.52
|
| 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 |
$1,729.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,375.92
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,366.00
|
| 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 |
$2,464.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,464.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,736.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$658.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,730.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,184.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,184.00
|
| 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 OF PAT DISC W/ANESTH
|
Facility
|
IP
|
$3,640.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
900501089
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$658.84 |
| Max. Negotiated Rate |
$2,730.00 |
| Rate for Payer: Adventist Health Commercial |
$728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,344.16
|
| Rate for Payer: Cash Price |
$1,638.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,464.28
|
| Rate for Payer: Heritage Provider Network Senior |
$2,464.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$658.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.00
|
| Rate for Payer: Multiplan Commercial |
$2,730.00
|
|
|
HC CL TREAT OF PAT DISC W/O ANEST
|
Facility
|
IP
|
$1,257.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
900501088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.52 |
| Max. Negotiated Rate |
$942.75 |
| Rate for Payer: Adventist Health Commercial |
$251.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$809.51
|
| Rate for Payer: Cash Price |
$565.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$850.99
|
| Rate for Payer: Heritage Provider Network Senior |
$850.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.25
|
| Rate for Payer: Multiplan Commercial |
$942.75
|
|
|
HC CL TREAT OF PAT DISC W/O ANEST
|
Facility
|
OP
|
$1,257.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
900501088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$251.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$776.83
|
| 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 |
$597.08
|
| Rate for Payer: Blue Shield of California EPN |
$475.15
|
| Rate for Payer: Cash Price |
$565.65
|
| Rate for Payer: Cash Price |
$565.65
|
| Rate for Payer: Cash Price |
$565.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$817.05
|
| 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 |
$850.99
|
| Rate for Payer: Heritage Provider Network Senior |
$850.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$599.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$227.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$942.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$754.20
|
| Rate for Payer: TriValley Medical Group Senior |
$754.20
|
| 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 OF PATELLAR FX,W/O MA
|
Facility
|
IP
|
$428.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
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 OF PATELLAR FX,W/O MA
|
Facility
|
OP
|
$428.00
|
|
|
Service Code
|
CPT 27520
|
| Hospital Charge Code |
900501455
|
|
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 OF PROX HUM FRAC W/MA
|
Facility
|
OP
|
$3,746.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
900501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$749.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,315.03
|
| 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 |
$1,779.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,415.99
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,434.90
|
| 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 |
$2,536.04
|
| Rate for Payer: Heritage Provider Network Senior |
$2,536.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,786.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$678.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,809.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,247.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,247.60
|
| 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 OF PROX HUM FRAC W/MA
|
Facility
|
IP
|
$3,746.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
900501059
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$2,809.50 |
| Rate for Payer: Adventist Health Commercial |
$749.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,412.42
|
| Rate for Payer: Cash Price |
$1,685.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,536.04
|
| Rate for Payer: Heritage Provider Network Senior |
$2,536.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$678.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.50
|
| Rate for Payer: Multiplan Commercial |
$2,809.50
|
|
|
HC CL TREAT OF RAD ELBOW CHILD
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.23 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$298.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$922.67
|
| 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 |
$709.17
|
| Rate for Payer: Blue Shield of California EPN |
$564.35
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$970.45
|
| 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 |
$1,010.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$712.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,119.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$895.80
|
| Rate for Payer: TriValley Medical Group Senior |
$895.80
|
| 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 OF RAD ELBOW CHILD
|
Facility
|
IP
|
$1,493.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
900501065
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$270.23 |
| Max. Negotiated Rate |
$1,119.75 |
| Rate for Payer: Adventist Health Commercial |
$298.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$961.49
|
| Rate for Payer: Cash Price |
$671.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,010.76
|
| Rate for Payer: Heritage Provider Network Senior |
$1,010.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.25
|
| Rate for Payer: Multiplan Commercial |
$1,119.75
|
|
|
HC CL TREAT OF RAD & ULN SHAFT FR
|
Facility
|
OP
|
$1,245.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$769.41
|
| 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 |
$591.38
|
| Rate for Payer: Blue Shield of California EPN |
$470.61
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$809.25
|
| 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 |
$842.87
|
| Rate for Payer: Heritage Provider Network Senior |
$842.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$593.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$747.00
|
| Rate for Payer: TriValley Medical Group Senior |
$747.00
|
| 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 OF RAD & ULN SHAFT FR
|
Facility
|
IP
|
$1,245.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
900501069
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$225.34 |
| Max. Negotiated Rate |
$933.75 |
| Rate for Payer: Adventist Health Commercial |
$249.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$801.78
|
| Rate for Payer: Cash Price |
$560.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$842.87
|
| Rate for Payer: Heritage Provider Network Senior |
$842.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$225.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.25
|
| Rate for Payer: Multiplan Commercial |
$933.75
|
|
|
HC CL TREAT OF SHLD DISLOC W/MANI
|
Facility
|
IP
|
$1,510.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.31 |
| Max. Negotiated Rate |
$1,132.50 |
| Rate for Payer: Adventist Health Commercial |
$302.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$972.44
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,022.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,022.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.50
|
| Rate for Payer: Multiplan Commercial |
$1,132.50
|
|
|
HC CL TREAT OF SHLD DISLOC W/MANI
|
Facility
|
OP
|
$1,510.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
900501060
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$273.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$302.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$933.18
|
| 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 |
$717.25
|
| Rate for Payer: Blue Shield of California EPN |
$570.78
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cash Price |
$679.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$981.50
|
| 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 |
$1,022.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,022.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$720.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$273.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,132.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$906.00
|
| Rate for Payer: TriValley Medical Group Senior |
$906.00
|
| 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 OF TIB SHFT FRAC W/WO
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
900501233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$706.99
|
| 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 |
$543.40
|
| Rate for Payer: Blue Shield of California EPN |
$432.43
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$743.60
|
| 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 |
$774.49
|
| Rate for Payer: Heritage Provider Network Senior |
$774.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$545.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$858.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$686.40
|
| Rate for Payer: TriValley Medical Group Senior |
$686.40
|
| 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 OF TIB SHFT FRAC W/WO
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 27750
|
| Hospital Charge Code |
900501233
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$736.74
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$774.49
|
| Rate for Payer: Heritage Provider Network Senior |
$774.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$858.00
|
|
|
HC CL TREAT OF TM DIS INT OR SUBQ
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$570.41
|
| 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 |
$438.43
|
| Rate for Payer: Blue Shield of California EPN |
$348.89
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$599.95
|
| 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 |
$624.87
|
| Rate for Payer: Heritage Provider Network Senior |
$624.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$440.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$553.80
|
| Rate for Payer: TriValley Medical Group Senior |
$553.80
|
| 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 OF TM DIS INT OR SUBQ
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
CPT 21480
|
| Hospital Charge Code |
900501057
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$167.06 |
| Max. Negotiated Rate |
$692.25 |
| Rate for Payer: Adventist Health Commercial |
$184.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$594.41
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.87
|
| Rate for Payer: Heritage Provider Network Senior |
$624.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.75
|
| Rate for Payer: Multiplan Commercial |
$692.25
|
|
