|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
IP
|
$480.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$86.88 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$96.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$329.76
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$324.96
|
| Rate for Payer: Heritage Provider Network Senior |
$324.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
OP
|
$954.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$655.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$620.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.86
|
| Rate for Payer: Heritage Provider Network Senior |
$645.86
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$459.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$346.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$318.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
IP
|
$954.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.67 |
| Max. Negotiated Rate |
$715.50 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$655.40
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.86
|
| Rate for Payer: Heritage Provider Network Senior |
$645.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
IP
|
$392.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: Blue Shield of California Commercial |
$165.42
|
| Rate for Payer: Blue Shield of California EPN |
$157.58
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.38
|
| Rate for Payer: Heritage Provider Network Senior |
$265.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
|
|
HC CLOS TREAT POST ANKLE FX W/MAN
|
Facility
OP
|
$392.00
|
|
|
Service Code
|
CPT 27768
|
| Hospital Charge Code |
900501747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$269.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$254.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$265.38
|
| Rate for Payer: Heritage Provider Network Senior |
$265.38
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$188.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$142.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$130.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC CLOSTRIDIUM DIFFICILE GDH
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
900913622
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$13.10
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$41.22
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.62
|
| Rate for Payer: Heritage Provider Network Senior |
$40.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
|
|
HC CLOSTRIDIUM DIFFICILE TOXIN
|
Facility
OP
|
$46.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
900913623
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$75.23 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$27.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$31.60
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.23
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$56.72
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$29.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: Dignity Health Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$11.98
|
| Rate for Payer: Heritage Provider Network Commercial |
$28.47
|
| Rate for Payer: Heritage Provider Network Senior |
$28.47
|
| Rate for Payer: Humana Medicare |
$11.98
|
| Rate for Payer: IEHP Medi-Cal |
$13.09
|
| Rate for Payer: IEHP Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$22.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.09
|
| Rate for Payer: Multiplan Commercial |
$34.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$11.98
|
| Rate for Payer: TriValley Medical Group Senior |
$11.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$12.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$12.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
IP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$12,173.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$485.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,173.00
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$465.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$546.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$685.12
|
| Rate for Payer: Heritage Provider Network Senior |
$685.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$368.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$338.11
|
|
|
HC CLOSURE DEVICE, VASCULAR
|
Facility
OP
|
$1,012.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
909081723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$12,139.00 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$485.76
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$695.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,139.00
|
| Rate for Payer: Blue Shield of California Commercial |
$628.45
|
| Rate for Payer: Blue Shield of California EPN |
$594.04
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$465.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Senior |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$647.68
|
| Rate for Payer: Heritage Provider Network Commercial |
$468.56
|
| Rate for Payer: Heritage Provider Network Senior |
$468.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$506.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$368.98
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$338.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,007.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$952.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$706.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$532.30
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$489.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC CLSD TRMT SCAPULAR FX W/MANIPU
|
Facility
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 23575
|
| Hospital Charge Code |
900501682
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$1,099.50 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,007.14
|
| Rate for Payer: Cash Price |
$659.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
OP
|
$807.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$524.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$546.34
|
| Rate for Payer: Heritage Provider Network Senior |
$546.34
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$388.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$293.02
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$269.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLSD TX PST MALLS FRC WO MANIP
|
Facility
IP
|
$807.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
900027767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.07 |
| Max. Negotiated Rate |
$605.25 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$554.41
|
| Rate for Payer: Blue Shield of California Commercial |
$340.55
|
| Rate for Payer: Blue Shield of California EPN |
$324.41
|
| Rate for Payer: Cash Price |
$363.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$546.34
|
| Rate for Payer: Heritage Provider Network Senior |
$546.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
OP
|
$10,306.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,061.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,799.12
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,080.22
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8,760.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,668.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,729.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$4,637.70
|
| Rate for Payer: Cash Price |
$4,637.70
|
| Rate for Payer: Cash Price |
$4,637.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,698.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,760.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,760.10
|
| Rate for Payer: Dignity Health Senior |
$8,760.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,379.41
|
| Rate for Payer: Heritage Provider Network Senior |
$6,379.41
|
| Rate for Payer: IEHP Medi-Cal |
$936.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,967.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,865.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.50
|
| Rate for Payer: Multiplan Commercial |
$7,729.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,760.10
|
| Rate for Payer: Vantage Medical Group Senior |
$8,760.10
|
|
|
HC CLSR INTSTNL CUTANEOUS FISTULA
|
Facility
IP
|
$10,306.00
|
|
|
Service Code
|
CPT 44640
|
| Hospital Charge Code |
906744640
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,865.39 |
| Max. Negotiated Rate |
$7,729.50 |
| Rate for Payer: Adventist Health Commercial |
$2,061.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,080.22
|
| Rate for Payer: Cash Price |
$4,637.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,977.16
|
| Rate for Payer: Heritage Provider Network Senior |
$6,977.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,865.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,576.50
|
| Rate for Payer: Multiplan Commercial |
$7,729.50
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
OP
|
$1,424.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$284.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$925.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.05
|
| Rate for Payer: Heritage Provider Network Senior |
$964.05
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$686.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$517.05
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$475.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT/ACROMIOCLAVICULAR DIS
|
Facility
IP
|
$1,424.00
|
|
|
Service Code
|
CPT 23540
|
| Hospital Charge Code |
900501581
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$1,068.00 |
| Rate for Payer: Adventist Health Commercial |
$284.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.29
|
| Rate for Payer: Cash Price |
$640.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.05
|
| Rate for Payer: Heritage Provider Network Senior |
$964.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.00
|
| Rate for Payer: Multiplan Commercial |
$1,068.00
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
IP
|
$1,040.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$714.48
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.08
|
| Rate for Payer: Heritage Provider Network Senior |
$704.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.00
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
|
|
HC CL TREAT ANK DISLOC W/O ANESTH
|
Facility
OP
|
$1,040.00
|
|
|
Service Code
|
CPT 27840
|
| Hospital Charge Code |
900501096
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$714.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$676.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$704.08
|
| Rate for Payer: Heritage Provider Network Senior |
$704.08
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$501.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$377.62
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$347.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CL TREAT ANKLE DISCLOC W/ANES
|
Facility
OP
|
$3,370.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$674.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,315.19
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,190.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,281.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,281.49
|
| Rate for Payer: Humana Medicare |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,624.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| Rate for Payer: Multiplan Commercial |
$2,527.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,223.65
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,125.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC CL TREAT ANKLE DISCLOC W/ANES
|
Facility
IP
|
$3,370.00
|
|
|
Service Code
|
CPT 27842
|
| Hospital Charge Code |
900501589
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$609.97 |
| Max. Negotiated Rate |
$2,527.50 |
| Rate for Payer: Adventist Health Commercial |
$674.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,315.19
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,281.49
|
| Rate for Payer: Heritage Provider Network Senior |
$2,281.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$609.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.50
|
| Rate for Payer: Multiplan Commercial |
$2,527.50
|
|
|
HC CL TREAT ANKLE MM FX W/O MANIP
|
Facility
IP
|
$987.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
900501371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: Blue Shield of California Commercial |
$416.51
|
| Rate for Payer: Blue Shield of California EPN |
$396.77
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.20
|
| Rate for Payer: Heritage Provider Network Senior |
$668.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
|
|
HC CL TREAT ANKLE MM FX W/O MANIP
|
Facility
OP
|
$987.00
|
|
|
Service Code
|
CPT 27760
|
| Hospital Charge Code |
900501371
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.65 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$197.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$678.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cash Price |
$444.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$641.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: Dignity Health Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$294.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$668.20
|
| Rate for Payer: Heritage Provider Network Senior |
$668.20
|
| Rate for Payer: Humana Medicare |
$294.64
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$475.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.25
|
| Rate for Payer: Multiplan Commercial |
$740.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$358.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$329.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
