|
HC CL TREAT OF ULN SHAFT FRAC W/O
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: 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 OF ULN SHAFT FRAC W/O
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 25530
|
| Hospital Charge Code |
900501068
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$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 OF WRIST DISLOCATION
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$563.00
|
| 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 |
$432.73
|
| Rate for Payer: Blue Shield of California EPN |
$344.36
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$592.15
|
| 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 |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$434.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Senior |
$546.60
|
| 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 WRIST DISLOCATION
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 25660
|
| Hospital Charge Code |
900501457
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.89 |
| Max. Negotiated Rate |
$683.25 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$586.68
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$616.75
|
| Rate for Payer: Heritage Provider Network Senior |
$616.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.75
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
|
|
HC CL TREAT PHAL SHFT FX W/MANI
|
Facility
|
OP
|
$1,685.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,041.33
|
| 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 |
$800.38
|
| Rate for Payer: Blue Shield of California EPN |
$636.93
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,095.25
|
| 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 |
$1,140.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,140.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$803.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,263.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,011.00
|
| Rate for Payer: TriValley Medical Group Senior |
$1,011.00
|
| 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 PHAL SHFT FX W/MANI
|
Facility
|
IP
|
$1,685.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
900501078
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.99 |
| Max. Negotiated Rate |
$1,263.75 |
| Rate for Payer: Adventist Health Commercial |
$337.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,085.14
|
| Rate for Payer: Cash Price |
$758.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,140.74
|
| Rate for Payer: Heritage Provider Network Senior |
$1,140.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$304.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.25
|
| Rate for Payer: Multiplan Commercial |
$1,263.75
|
|
|
HC CL TREAT POST HIP ARTHOPLAS
|
Facility
|
IP
|
$3,973.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
900501084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$719.11 |
| Max. Negotiated Rate |
$2,979.75 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,558.61
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,689.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,689.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$719.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.25
|
| Rate for Payer: Multiplan Commercial |
$2,979.75
|
|
|
HC CL TREAT POST HIP ARTHOPLAS
|
Facility
|
OP
|
$3,973.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
900501084
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$719.11 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$794.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,455.31
|
| 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 |
$1,887.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,501.79
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Cash Price |
$1,787.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,582.45
|
| 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 |
$2,689.72
|
| Rate for Payer: Heritage Provider Network Senior |
$2,689.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,895.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$719.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$2,979.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,383.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,383.80
|
| 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 POST HIP ARTH W/O ANE
|
Facility
|
IP
|
$1,144.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.06 |
| Max. Negotiated Rate |
$858.00 |
| Rate for Payer: Adventist Health Commercial |
$228.80
|
| Rate for Payer: 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 POST HIP ARTH W/O ANE
|
Facility
|
OP
|
$1,144.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
900501222
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$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 PROXIMAL HUMERAL FX
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: 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 PROXIMAL HUMERAL FX
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 23600
|
| Hospital Charge Code |
900501385
|
|
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 RADIAL HEAD/NECK FX
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: 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 RADIAL HEAD/NECK FX
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 24650
|
| Hospital Charge Code |
900501578
|
|
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 RADIAL SHAFT FRX W/DI
|
Facility
|
OP
|
$2,444.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$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 RADIAL SHAFT FRX W/DI
|
Facility
|
IP
|
$2,444.00
|
|
|
Service Code
|
CPT 25520
|
| Hospital Charge Code |
900501323
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$442.36 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$488.80
|
| Rate for Payer: 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 RADIAL SHAFT FX W/O M
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: 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 RADIAL SHAFT FX W/O M
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 25500
|
| Hospital Charge Code |
900501372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$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 RADIOULNAR DIS W/MANI
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$674.86
|
| 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 |
$518.70
|
| Rate for Payer: Blue Shield of California EPN |
$412.78
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$709.80
|
| 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 |
$739.28
|
| Rate for Payer: Heritage Provider Network Senior |
$739.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$520.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$655.20
|
| Rate for Payer: TriValley Medical Group Senior |
$655.20
|
| 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 RADIOULNAR DIS W/MANI
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
900501356
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$197.65 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$703.25
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$739.28
|
| Rate for Payer: Heritage Provider Network Senior |
$739.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
|
|
HC CL TREAT RADIUS/ULNA FX,W/O MA
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$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 |
$5,158.00
|
| 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 RADIUS/ULNA FX,W/O MA
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
900501390
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$195.30 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: 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 RAD SHAFT FRX W/MANIP
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
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 RAD SHAFT FRX W/MANIP
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
900501067
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.59 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Cash Price |
$573.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$828.10
|
| 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 |
$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 |
$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: 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 |
$862.50
|
| Rate for Payer: Heritage Provider Network Senior |
$862.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| 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 |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$955.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| 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 |
$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 SCAPULAR FX, W/O MANI
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 23570
|
| Hospital Charge Code |
900501452
|
|
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
|
|
