|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$5,876.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,175.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,036.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,644.20
|
| Rate for Payer: Cash Price |
$2,644.20
|
| Rate for Payer: Cash Price |
$2,644.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,819.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,978.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,978.05
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,832.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,063.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,469.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$4,407.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,133.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,963.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$5,876.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,063.56 |
| Max. Negotiated Rate |
$4,407.00 |
| Rate for Payer: Adventist Health Commercial |
$1,175.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,036.81
|
| Rate for Payer: Cash Price |
$2,644.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,978.05
|
| Rate for Payer: Heritage Provider Network Senior |
$3,978.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,063.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,469.00
|
| Rate for Payer: Multiplan Commercial |
$4,407.00
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
OP
|
$15,171.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$11,378.25 |
| Rate for Payer: Adventist Health Commercial |
$3,034.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,422.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,316.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,054.00
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,861.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,048.59
|
| Rate for Payer: Dignity Health Senior |
$7,316.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,316.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,270.77
|
| Rate for Payer: Heritage Provider Network Senior |
$10,270.77
|
| Rate for Payer: Humana Medicare |
$7,316.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,316.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,312.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,745.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,792.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,219.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,219.29
|
| Rate for Payer: Multiplan Commercial |
$11,378.25
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,508.59
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,068.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,975.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,048.59
|
| Rate for Payer: Vantage Medical Group Senior |
$7,316.90
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
IP
|
$15,171.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,745.95 |
| Max. Negotiated Rate |
$11,378.25 |
| Rate for Payer: Adventist Health Commercial |
$3,034.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,422.48
|
| Rate for Payer: Cash Price |
$6,826.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,270.77
|
| Rate for Payer: Heritage Provider Network Senior |
$10,270.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,745.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,792.75
|
| Rate for Payer: Multiplan Commercial |
$11,378.25
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
OP
|
$17,413.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$92.35 |
| Max. Negotiated Rate |
$13,479.00 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,962.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,813.47
|
| Rate for Payer: Blue Shield of California EPN |
$10,221.43
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,318.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,778.65
|
| Rate for Payer: Heritage Provider Network Senior |
$4,974.38
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,151.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,448.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$13,479.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$11,381.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
IP
|
$17,413.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$3,151.75 |
| Max. Negotiated Rate |
$13,059.75 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,962.73
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,788.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,788.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,151.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.25
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
OP
|
$10,990.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$2,198.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,550.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$4,945.50
|
| Rate for Payer: Cash Price |
$4,945.50
|
| Rate for Payer: Cash Price |
$4,945.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,143.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,440.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,440.23
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,297.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,747.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$8,242.50
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,990.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,671.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
IP
|
$10,990.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,989.19 |
| Max. Negotiated Rate |
$8,242.50 |
| Rate for Payer: Adventist Health Commercial |
$2,198.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,550.13
|
| Rate for Payer: Cash Price |
$4,945.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,440.23
|
| Rate for Payer: Heritage Provider Network Senior |
$7,440.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,989.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,747.50
|
| Rate for Payer: Multiplan Commercial |
$8,242.50
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
IP
|
$17,413.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,151.75 |
| Max. Negotiated Rate |
$13,059.75 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,962.73
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,788.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,788.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,151.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.25
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
OP
|
$17,413.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$3,482.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,962.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cash Price |
$7,835.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,318.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,788.60
|
| Rate for Payer: Heritage Provider Network Senior |
$11,788.60
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,393.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,151.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$13,059.75
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,322.66
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,817.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.38 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$752.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$822.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$712.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$931.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$931.60
|
| Rate for Payer: Dignity Health Senior |
$931.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$741.99
|
| Rate for Payer: Heritage Provider Network Senior |
$741.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$528.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$397.96
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$931.60
|
| Rate for Payer: Vantage Medical Group Senior |
$931.60
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.38 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$752.95
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$741.99
|
| Rate for Payer: Heritage Provider Network Senior |
$741.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
OP
|
$844.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$633.00 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$100.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Blue Shield of California Commercial |
$524.12
|
| Rate for Payer: Blue Shield of California EPN |
$495.43
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$548.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: Dignity Health Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$548.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$113.54
|
| Rate for Payer: Heritage Provider Network Commercial |
$522.44
|
| Rate for Payer: Heritage Provider Network Senior |
$522.44
|
| Rate for Payer: Humana Medicare |
$113.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$215.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$143.06
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$113.54
|
| Rate for Payer: TriValley Medical Group Senior |
$113.54
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$71.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$71.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
IP
|
$844.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$152.76 |
| Max. Negotiated Rate |
$633.00 |
| Rate for Payer: Adventist Health Commercial |
$168.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$579.83
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$571.39
|
| Rate for Payer: Heritage Provider Network Senior |
$571.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.00
|
| Rate for Payer: Multiplan Commercial |
$633.00
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$45.07
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.87
|
| Rate for Payer: Blue Shield of California Commercial |
$104.24
|
| Rate for Payer: Blue Shield of California EPN |
$59.28
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$299.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Senior |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.74
|
| Rate for Payer: Heritage Provider Network Senior |
$284.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$221.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$316.02
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$311.42
|
| Rate for Payer: Heritage Provider Network Senior |
$311.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$772.65 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$73.84
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$624.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| Rate for Payer: Blue Shield of California Commercial |
$179.60
|
| Rate for Payer: Blue Shield of California EPN |
$102.13
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$590.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Senior |
$772.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$590.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$562.67
|
| Rate for Payer: Heritage Provider Network Senior |
$562.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$438.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.25
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$164.53 |
| Max. Negotiated Rate |
$681.75 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$624.48
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.39
|
| Rate for Payer: Heritage Provider Network Senior |
$615.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.25
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
IP
|
$4,043.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$731.78 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,737.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,737.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
OP
|
$4,043.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$731.78 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$808.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,777.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cash Price |
$1,819.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,627.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: Dignity Health Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,120.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,737.11
|
| Rate for Payer: Heritage Provider Network Senior |
$2,737.11
|
| Rate for Payer: Humana Medicare |
$2,120.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,948.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,502.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,010.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,671.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,671.98
|
| Rate for Payer: Multiplan Commercial |
$3,032.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,468.01
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,350.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$75.66 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.17
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$282.99
|
| Rate for Payer: Heritage Provider Network Senior |
$282.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.50
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$67.22 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$287.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Blue Shield of California Commercial |
$155.22
|
| Rate for Payer: Blue Shield of California EPN |
$88.27
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$271.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: Dignity Health Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$137.36
|
| Rate for Payer: Heritage Provider Network Commercial |
$258.74
|
| Rate for Payer: Heritage Provider Network Senior |
$258.74
|
| Rate for Payer: Humana Medicare |
$137.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$67.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$260.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.07
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$137.36
|
| Rate for Payer: TriValley Medical Group Senior |
$137.36
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$154.10
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$154.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OPIATES CONF & ID
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.05 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Adventist Health Commercial |
$54.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$186.18
|
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.47
|
| Rate for Payer: Heritage Provider Network Senior |
$183.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.75
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
|
|
HC OPIATES CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$191.25 |
| Rate for Payer: Adventist Health Commercial |
$45.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$0.02
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$154.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$146.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: Dignity Health Senior |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$139.28
|
| Rate for Payer: Heritage Provider Network Senior |
$139.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$108.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.25
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC OPTIC FORAMINA
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.86 |
| Max. Negotiated Rate |
$376.50 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$344.87
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$339.85
|
| Rate for Payer: Heritage Provider Network Senior |
$339.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.50
|
| Rate for Payer: Multiplan Commercial |
$376.50
|
|
