|
HC REPAIR HAND JOINT
|
Facility
|
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| 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 |
$7,436.00
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| 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 |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| 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 |
$1,760.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| 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 |
$2,739.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,326.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,220.47
|
| 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 REPAIR INTL INGUINAL HERNIA
|
Facility
|
OP
|
$7,094.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,418.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,873.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,611.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,802.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,802.64
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,419.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,284.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$5,320.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,575.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,370.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
IP
|
$7,094.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,284.01 |
| Max. Negotiated Rate |
$5,320.50 |
| Rate for Payer: Adventist Health Commercial |
$1,418.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,873.58
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,802.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,802.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,284.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.50
|
| Rate for Payer: Multiplan Commercial |
$5,320.50
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
IP
|
$9,684.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,752.80 |
| Max. Negotiated Rate |
$7,263.00 |
| Rate for Payer: Adventist Health Commercial |
$1,936.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,652.91
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,556.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,556.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,752.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.00
|
| Rate for Payer: Multiplan Commercial |
$7,263.00
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
OP
|
$9,684.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,795.32 |
| Rate for Payer: Adventist Health Commercial |
$1,936.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,652.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,294.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: Dignity Health Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,294.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,530.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,556.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,556.07
|
| Rate for Payer: Humana Medicare |
$6,530.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,667.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,752.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,705.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,228.06
|
| Rate for Payer: Multiplan Commercial |
$7,263.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,516.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,235.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
IP
|
$2,914.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$2,185.50 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
OP
|
$2,914.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,894.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,404.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,058.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
IP
|
$2,914.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$2,185.50 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
OP
|
$2,914.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,894.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,404.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,058.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
OP
|
$9,560.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,912.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,567.72
|
| 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: Cash Price |
$4,302.00
|
| Rate for Payer: Cash Price |
$4,302.00
|
| Rate for Payer: Cash Price |
$4,302.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,214.00
|
| 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 |
$6,472.12
|
| Rate for Payer: Heritage Provider Network Senior |
$6,472.12
|
| 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 |
$4,607.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,730.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,390.00
|
| 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 |
$7,170.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,471.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,194.00
|
| 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 REPAIR MUSCLES OF HAND, EA
|
Facility
|
IP
|
$9,560.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,730.36 |
| Max. Negotiated Rate |
$7,170.00 |
| Rate for Payer: Adventist Health Commercial |
$1,912.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,567.72
|
| Rate for Payer: Cash Price |
$4,302.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,472.12
|
| Rate for Payer: Heritage Provider Network Senior |
$6,472.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,730.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,390.00
|
| Rate for Payer: Multiplan Commercial |
$7,170.00
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
IP
|
$5,699.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,031.52 |
| Max. Negotiated Rate |
$4,274.25 |
| Rate for Payer: Adventist Health Commercial |
$1,139.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,915.21
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,858.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,858.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.75
|
| Rate for Payer: Multiplan Commercial |
$4,274.25
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
OP
|
$5,699.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,795.32 |
| Rate for Payer: Adventist Health Commercial |
$1,139.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,915.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cash Price |
$2,564.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,704.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: Dignity Health Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,704.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,530.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,858.22
|
| Rate for Payer: Heritage Provider Network Senior |
$3,858.22
|
| Rate for Payer: Humana Medicare |
$6,530.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,746.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,031.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,705.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,424.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,228.06
|
| Rate for Payer: Multiplan Commercial |
$4,274.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,069.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,904.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$4,818.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$872.06 |
| Max. Negotiated Rate |
$4,547.00 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,131.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: Dignity Health Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,131.70
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,919.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
| Rate for Payer: Humana Medicare |
$2,919.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,322.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,678.78
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,749.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,609.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$4,818.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$872.06 |
| Max. Negotiated Rate |
$3,613.50 |
| Rate for Payer: Adventist Health Commercial |
$963.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,309.97
|
| Rate for Payer: Cash Price |
$2,168.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,261.79
|
| Rate for Payer: Heritage Provider Network Senior |
$3,261.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$872.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.50
|
| Rate for Payer: Multiplan Commercial |
$3,613.50
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
OP
|
$3,345.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$12,620.00 |
| Rate for Payer: Adventist Health Commercial |
$669.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$12,620.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,298.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,843.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,839.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,508.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,576.00
|
| 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 |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,174.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,843.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,843.25
|
| Rate for Payer: Dignity Health Senior |
$2,843.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,070.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,070.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$315.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,612.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.25
|
| Rate for Payer: Multiplan Commercial |
$2,508.75
|
| 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 |
$2,843.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,843.25
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
IP
|
$3,345.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$605.44 |
| Max. Negotiated Rate |
$2,508.75 |
| Rate for Payer: Adventist Health Commercial |
$669.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,298.02
|
| Rate for Payer: Cash Price |
$1,505.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,264.56
|
| Rate for Payer: Heritage Provider Network Senior |
$2,264.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$605.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$836.25
|
| Rate for Payer: Multiplan Commercial |
$2,508.75
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$7,756.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,403.84 |
| Max. Negotiated Rate |
$5,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,551.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,328.37
|
| Rate for Payer: Cash Price |
$3,490.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,250.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5,250.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,403.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,939.00
|
| Rate for Payer: Multiplan Commercial |
$5,817.00
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$7,756.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$1,551.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,328.37
|
| 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 |
$3,490.20
|
| Rate for Payer: Cash Price |
$3,490.20
|
| Rate for Payer: Cash Price |
$3,490.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,041.40
|
| 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 |
$5,250.81
|
| Rate for Payer: Heritage Provider Network Senior |
$5,250.81
|
| 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 |
$3,738.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,403.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,939.00
|
| 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 |
$5,817.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,816.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,591.28
|
| 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 REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$8,733.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,580.67 |
| Max. Negotiated Rate |
$6,549.75 |
| Rate for Payer: Adventist Health Commercial |
$1,746.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,999.57
|
| Rate for Payer: Cash Price |
$3,929.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,912.24
|
| Rate for Payer: Heritage Provider Network Senior |
$5,912.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,580.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.25
|
| Rate for Payer: Multiplan Commercial |
$6,549.75
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$8,733.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$10,975.35 |
| Rate for Payer: Adventist Health Commercial |
$1,746.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,999.57
|
| 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 |
$4,547.00
|
| Rate for Payer: Cash Price |
$3,929.85
|
| Rate for Payer: Cash Price |
$3,929.85
|
| Rate for Payer: Cash Price |
$3,929.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,676.45
|
| 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 |
$5,912.24
|
| Rate for Payer: Heritage Provider Network Senior |
$5,912.24
|
| 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 |
$4,209.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,580.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,633.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,183.25
|
| 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 |
$6,549.75
|
| Rate for Payer: Multiplan WC |
$10,003.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,170.95
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,917.70
|
| 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 REPAIR PROFUNDUS TENDON
|
Facility
|
OP
|
$6,033.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$126.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,206.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,144.67
|
| 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 |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,746.49
|
| Rate for Payer: Blue Shield of California EPN |
$3,541.37
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,921.45
|
| 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 |
$3,734.43
|
| 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 |
$126.61
|
| 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 |
$1,091.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,508.25
|
| 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 |
$4,524.75
|
| 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 |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| 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 REPAIR PROFUNDUS TENDON
|
Facility
|
IP
|
$6,033.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,091.97 |
| Max. Negotiated Rate |
$4,524.75 |
| Rate for Payer: Adventist Health Commercial |
$1,206.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,144.67
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,084.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,084.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,091.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,508.25
|
| Rate for Payer: Multiplan Commercial |
$4,524.75
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$89.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$352.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.56
|
| Rate for Payer: Dignity Health Senior |
$196.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$196.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Humana Medicare |
$196.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$196.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$261.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$232.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.06
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$197.16
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$181.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.56
|
| Rate for Payer: Vantage Medical Group Senior |
$196.87
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$98.28 |
| Max. Negotiated Rate |
$407.25 |
| Rate for Payer: Adventist Health Commercial |
$108.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$373.04
|
| Rate for Payer: Cash Price |
$244.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$367.61
|
| Rate for Payer: Heritage Provider Network Senior |
$367.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$407.25
|
|
