|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$4,626.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.31 |
| Max. Negotiated Rate |
$3,469.50 |
| Rate for Payer: Adventist Health Commercial |
$925.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,178.06
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,131.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,131.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.50
|
| Rate for Payer: Multiplan Commercial |
$3,469.50
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$4,626.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$925.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,178.06
|
| 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 |
$2,081.70
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,006.90
|
| 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 |
$3,131.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,131.80
|
| 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 |
$2,229.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.50
|
| 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 |
$3,469.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,679.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,545.55
|
| 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 TENDON,LEG PRIM W/O GRF
|
Facility
|
IP
|
$4,774.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$3,580.50 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| Rate for Payer: Blue Shield of California Commercial |
$2,014.63
|
| Rate for Payer: Blue Shield of California EPN |
$1,919.15
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| Rate for Payer: Multiplan Commercial |
$3,580.50
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
OP
|
$4,774.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$864.09 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$954.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,279.74
|
| 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 |
$3,237.00
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cash Price |
$2,148.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,103.10
|
| 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 |
$3,232.00
|
| Rate for Payer: Heritage Provider Network Senior |
$3,232.00
|
| 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 |
$2,301.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$864.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,193.50
|
| 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 |
$3,580.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,733.44
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,594.99
|
| 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 TENDON/MUSCLE PRIM SNGL
|
Facility
|
IP
|
$6,736.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,219.22 |
| Max. Negotiated Rate |
$5,052.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| Rate for Payer: Multiplan Commercial |
$5,052.00
|
|
|
HC REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
OP
|
$6,736.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,347.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,627.63
|
| 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 |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cash Price |
$3,031.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,378.40
|
| 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 |
$4,560.27
|
| Rate for Payer: Heritage Provider Network Senior |
$4,560.27
|
| 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 |
$3,246.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,219.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,684.00
|
| 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 |
$5,052.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,445.84
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,250.50
|
| 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 TONGUE LACERATION GT 2.6C
|
Facility
|
IP
|
$4,014.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$726.53 |
| Max. Negotiated Rate |
$3,010.50 |
| Rate for Payer: Adventist Health Commercial |
$802.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,757.62
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,717.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,717.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.50
|
| Rate for Payer: Multiplan Commercial |
$3,010.50
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
OP
|
$4,014.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$802.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,757.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,609.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: Dignity Health Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$305.19
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,717.48
|
| Rate for Payer: Heritage Provider Network Senior |
$2,717.48
|
| Rate for Payer: Humana Medicare |
$305.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,934.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$360.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,003.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$3,010.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,457.48
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,341.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,617.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,351.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,743.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,313.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,208.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,617.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,351.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,238.92
|
| Rate for Payer: Heritage Provider Network Senior |
$965.43
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$71.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,491.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$863.39
|
| Rate for Payer: TriValley Medical Group Senior |
$863.39
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,617.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$2,712.75 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,617.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$2,712.75 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$3,617.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$2,712.75 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
OP
|
$3,617.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| 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 |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,351.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,238.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$179.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$5,976.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,081.66 |
| Max. Negotiated Rate |
$4,482.00 |
| Rate for Payer: Adventist Health Commercial |
$1,195.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,105.51
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,045.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,045.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,494.00
|
| Rate for Payer: Multiplan Commercial |
$4,482.00
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$5,976.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,246.18 |
| Rate for Payer: Adventist Health Commercial |
$1,195.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,105.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,884.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,313.87
|
| Rate for Payer: Dignity Health Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,830.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,045.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,045.75
|
| Rate for Payer: Humana Medicare |
$4,830.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,830.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,880.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,700.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,494.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,086.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,086.80
|
| Rate for Payer: Multiplan Commercial |
$4,482.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,169.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,996.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
IP
|
$9,418.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,704.66 |
| Max. Negotiated Rate |
$7,063.50 |
| Rate for Payer: Adventist Health Commercial |
$1,883.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,470.17
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,375.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,375.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,704.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.50
|
| Rate for Payer: Multiplan Commercial |
$7,063.50
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
OP
|
$9,418.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,883.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,470.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,121.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,375.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,375.99
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,539.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,704.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,063.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,419.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,146.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
OP
|
$8,648.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$10,299.10 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,168.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,140.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,889.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
IP
|
$8,648.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,565.29 |
| Max. Negotiated Rate |
$6,486.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
OP
|
$8,648.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,168.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,140.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,889.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
IP
|
$8,648.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,565.29 |
| Max. Negotiated Rate |
$6,486.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$1,679.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.90 |
| Max. Negotiated Rate |
$1,259.25 |
| Rate for Payer: Adventist Health Commercial |
$335.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,153.47
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,136.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,136.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.75
|
| Rate for Payer: Multiplan Commercial |
$1,259.25
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$1,679.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$335.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,153.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,091.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,136.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,136.68
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$809.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$1,259.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$609.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$560.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
|
