|
HC CL TREAT TIBIA SHAFT FX W/MAN
|
Facility
|
OP
|
$4,446.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
900501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$804.73 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$889.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,747.63
|
| 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 |
$2,111.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,680.59
|
| Rate for Payer: Cash Price |
$2,000.70
|
| Rate for Payer: Cash Price |
$2,000.70
|
| Rate for Payer: Cash Price |
$2,000.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,889.90
|
| 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 |
$3,009.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,009.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,120.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$804.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$3,334.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,667.60
|
| Rate for Payer: TriValley Medical Group Senior |
$2,667.60
|
| 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 TIBIA SHAFT FX W/MAN
|
Facility
|
IP
|
$4,446.00
|
|
|
Service Code
|
CPT 27752
|
| Hospital Charge Code |
900501090
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$804.73 |
| Max. Negotiated Rate |
$3,334.50 |
| Rate for Payer: Adventist Health Commercial |
$889.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,863.22
|
| Rate for Payer: Cash Price |
$2,000.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,009.94
|
| Rate for Payer: Heritage Provider Network Senior |
$3,009.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$804.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$3,334.50
|
|
|
HC CL TREAT TOE DSLOCATN W/O ANES
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
900501409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$506.76
|
| 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 |
$389.50
|
| Rate for Payer: Blue Shield of California EPN |
$309.96
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$533.00
|
| 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 |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$391.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$492.00
|
| Rate for Payer: TriValley Medical Group Senior |
$492.00
|
| 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 TOE DSLOCATN W/O ANES
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 28630
|
| Hospital Charge Code |
900501409
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.42 |
| Max. Negotiated Rate |
$615.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$528.08
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$555.14
|
| Rate for Payer: Heritage Provider Network Senior |
$555.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
|
|
HC CL TREAT TOE FX WO MAN EA
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
900501489
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$690.92
|
| 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 |
$531.05
|
| Rate for Payer: Blue Shield of California EPN |
$422.60
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$726.70
|
| 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 |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$533.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Senior |
$670.80
|
| 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 TOE FX WO MAN EA
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 28510
|
| Hospital Charge Code |
900501489
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$202.36 |
| Max. Negotiated Rate |
$838.50 |
| Rate for Payer: Adventist Health Commercial |
$223.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$719.99
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$756.89
|
| Rate for Payer: Heritage Provider Network Senior |
$756.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.50
|
| Rate for Payer: Multiplan Commercial |
$838.50
|
|
|
HC CL TREAT TRIMALLOR FX W/MANIPU
|
Facility
|
IP
|
$2,256.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
900501094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$1,692.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,452.86
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
|
|
HC CL TREAT TRIMALLOR FX W/MANIPU
|
Facility
|
OP
|
$2,256.00
|
|
|
Service Code
|
CPT 27818
|
| Hospital Charge Code |
900501094
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.34 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$451.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,394.21
|
| 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 |
$1,071.60
|
| Rate for Payer: Blue Shield of California EPN |
$852.77
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,466.40
|
| 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 |
$1,527.31
|
| Rate for Payer: Heritage Provider Network Senior |
$1,527.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,076.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,353.60
|
| Rate for Payer: TriValley Medical Group Senior |
$1,353.60
|
| 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 TROCHANTERIC FX WO MAN
|
Facility
|
IP
|
$1,314.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
900527246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.83 |
| Max. Negotiated Rate |
$985.50 |
| Rate for Payer: Adventist Health Commercial |
$262.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$846.22
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$889.58
|
| Rate for Payer: Heritage Provider Network Senior |
$889.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.50
|
| Rate for Payer: Multiplan Commercial |
$985.50
|
|
|
HC CL TREAT TROCHANTERIC FX WO MAN
|
Facility
|
OP
|
$1,314.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
900527246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.83 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$262.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$812.05
|
| 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 |
$624.15
|
| Rate for Payer: Blue Shield of California EPN |
$496.69
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cash Price |
$591.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$854.10
|
| 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 |
$889.58
|
| Rate for Payer: Heritage Provider Network Senior |
$889.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$626.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$237.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$328.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$985.50
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$788.40
|
| Rate for Payer: TriValley Medical Group Senior |
$788.40
|
| 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 ULNAR FX,PROXIMAL END
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
900501467
|
|
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 ULNAR FX,PROXIMAL END
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 24670
|
| Hospital Charge Code |
900501467
|
|
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 ULNAR FX, W/MANIPULAT
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$1,002.75 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$861.03
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
|
|
HC CL TREAT ULNAR FX, W/MANIPULAT
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
900501391
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$826.27
|
| 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 |
$635.08
|
| Rate for Payer: Blue Shield of California EPN |
$505.39
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$869.05
|
| 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 |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$637.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,378.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$802.20
|
| Rate for Payer: TriValley Medical Group Senior |
$802.20
|
| 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 ULNAR SHAFT FX W/MANI
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$826.27
|
| 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 |
$635.08
|
| Rate for Payer: Blue Shield of California EPN |
$505.39
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$869.05
|
| 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 |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$637.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$802.20
|
| Rate for Payer: TriValley Medical Group Senior |
$802.20
|
| 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 ULNAR SHAFT FX W/MANI
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
900501376
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.00 |
| Max. Negotiated Rate |
$1,002.75 |
| Rate for Payer: Adventist Health Commercial |
$267.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$861.03
|
| Rate for Payer: Cash Price |
$601.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$905.15
|
| Rate for Payer: Heritage Provider Network Senior |
$905.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$242.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.25
|
| Rate for Payer: Multiplan Commercial |
$1,002.75
|
|
|
HC CL TREAT ULNAR STYLOID FX
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
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 ULNAR STYLOID FX
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 25650
|
| Hospital Charge Code |
900501570
|
|
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 VERTEBRAL BODY FX W/O
|
Facility
|
OP
|
$2,259.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$451.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,396.06
|
| 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 |
$1,073.03
|
| Rate for Payer: Blue Shield of California EPN |
$853.90
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,468.35
|
| 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 |
$1,529.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,529.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,077.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,694.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,355.40
|
| Rate for Payer: TriValley Medical Group Senior |
$1,355.40
|
| 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 VERTEBRAL BODY FX W/O
|
Facility
|
IP
|
$2,259.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.88 |
| Max. Negotiated Rate |
$1,694.25 |
| Rate for Payer: Adventist Health Commercial |
$451.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,454.80
|
| Rate for Payer: Cash Price |
$1,016.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,529.34
|
| Rate for Payer: Heritage Provider Network Senior |
$1,529.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.75
|
| Rate for Payer: Multiplan Commercial |
$1,694.25
|
|
|
HC CL TREAT WRIST FX, W/MANIPULAT
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
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 WRIST FX, W/MANIPULAT
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
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 TRT FEM FX W/O MANIP PE NCK
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
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 TRT FEM FX W/O MANIP PE NCK
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
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 TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.55 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$428.90
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$450.88
|
| Rate for Payer: Heritage Provider Network Senior |
$450.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.50
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
|
