|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
OP
|
$14,851.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$11,976.10 |
| Rate for Payer: Adventist Health Commercial |
$2,970.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,202.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,653.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Senior |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,516.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,054.13
|
| Rate for Payer: Heritage Provider Network Senior |
$10,054.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,083.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,688.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,643.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,712.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,470.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,470.71
|
| Rate for Payer: Multiplan Commercial |
$11,138.25
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,343.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,917.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
IP
|
$16,022.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,899.98 |
| Max. Negotiated Rate |
$12,016.50 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,846.89
|
| Rate for Payer: Heritage Provider Network Senior |
$10,846.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,899.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,005.50
|
| Rate for Payer: Multiplan Commercial |
$12,016.50
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
OP
|
$16,022.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,016.50 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$11,007.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cash Price |
$7,209.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$10,414.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Senior |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,122.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,846.89
|
| Rate for Payer: Heritage Provider Network Senior |
$10,846.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,642.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,899.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,005.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,194.48
|
| Rate for Payer: Multiplan Commercial |
$12,016.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$5,764.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$5,304.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
OP
|
$12,006.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$2,401.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,248.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,803.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,128.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8,128.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,726.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,001.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$9,004.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,319.76
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,975.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
IP
|
$12,006.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,173.09 |
| Max. Negotiated Rate |
$9,004.50 |
| Rate for Payer: Adventist Health Commercial |
$2,401.20
|
| Rate for Payer: Cash Price |
$5,402.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,128.06
|
| Rate for Payer: Heritage Provider Network Senior |
$8,128.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,173.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,001.50
|
| Rate for Payer: Multiplan Commercial |
$9,004.50
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
OP
|
$13,490.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$2,698.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,267.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$8,768.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,132.73
|
| Rate for Payer: Heritage Provider Network Senior |
$9,132.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$6,434.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,441.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,372.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$10,117.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,853.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$4,466.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
IP
|
$13,490.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,441.69 |
| Max. Negotiated Rate |
$10,117.50 |
| Rate for Payer: Adventist Health Commercial |
$2,698.00
|
| Rate for Payer: Cash Price |
$6,070.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,132.73
|
| Rate for Payer: Heritage Provider Network Senior |
$9,132.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,441.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,372.50
|
| Rate for Payer: Multiplan Commercial |
$10,117.50
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| 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 |
$3,531.00
|
| 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 |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$522.79
|
| 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: Molina Healthcare of CA Medi-Cal |
$767.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$767.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$394.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$362.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$931.60
|
| 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: 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
|
$682.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$511.50 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$364.53
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$468.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Blue Shield of California Commercial |
$416.02
|
| Rate for Payer: Blue Shield of California EPN |
$332.82
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$443.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.30
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$422.16
|
| Rate for Payer: Heritage Provider Network Senior |
$422.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$325.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| 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 |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$123.44 |
| Max. Negotiated Rate |
$511.50 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$461.71
|
| Rate for Payer: Heritage Provider Network Senior |
$461.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$123.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.50
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$35.02 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$245.87
|
| 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 |
$178.73
|
| Rate for Payer: Blue Shield of California Commercial |
$107.38
|
| Rate for Payer: Blue Shield of California EPN |
$86.35
|
| 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 |
$35.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$219.42
|
| 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: Molina Healthcare of CA Medi-Cal |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$230.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| 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: 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
|
$994.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.11 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: Adventist Health Commercial |
$198.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$531.29
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$682.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$844.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$546.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$745.50
|
| Rate for Payer: Blue Shield of California Commercial |
$184.99
|
| Rate for Payer: Blue Shield of California EPN |
$148.76
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$646.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$844.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$844.90
|
| Rate for Payer: Dignity Health Senior |
$844.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$646.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.29
|
| Rate for Payer: Heritage Provider Network Senior |
$615.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$474.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$695.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$695.80
|
| Rate for Payer: Multiplan Commercial |
$745.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$497.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$497.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$844.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$844.90
|
| Rate for Payer: Vantage Medical Group Senior |
$844.90
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.91 |
| Max. Negotiated Rate |
$745.50 |
| Rate for Payer: Adventist Health Commercial |
$198.80
|
| Rate for Payer: Cash Price |
$447.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$672.94
|
| Rate for Payer: Heritage Provider Network Senior |
$672.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.50
|
| Rate for Payer: Multiplan Commercial |
$745.50
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,034.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,871.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Senior |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,191.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,106.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,519.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,760.80
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,589.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,462.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$799.48 |
| Max. Negotiated Rate |
$3,312.75 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Cash Price |
$1,987.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,990.31
|
| Rate for Payer: Heritage Provider Network Senior |
$2,990.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$799.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.89 |
| Max. Negotiated Rate |
$351.75 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$317.51
|
| Rate for Payer: Heritage Provider Network Senior |
$317.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.25
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.81 |
| Max. Negotiated Rate |
$351.75 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$250.68
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$322.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Blue Shield of California Commercial |
$159.89
|
| Rate for Payer: Blue Shield of California EPN |
$128.58
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$304.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$304.85
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$290.31
|
| Rate for Payer: Heritage Provider Network Senior |
$290.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$223.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC OPIATES CONF & ID
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.94 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$159.28
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$204.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.38
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Senior |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$184.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$142.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$149.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC OPIATES CONF & ID
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$269.25 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$243.04
|
| Rate for Payer: Heritage Provider Network Senior |
$243.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
|
|
HC OPTIC FORAMINA
|
Facility
|
OP
|
$572.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Adventist Health Commercial |
$114.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$305.73
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$392.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.39
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$105.38
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$371.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Senior |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$371.80
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.88
|
| Rate for Payer: Heritage Provider Network Commercial |
$354.07
|
| Rate for Payer: Heritage Provider Network Senior |
$354.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$272.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.97
|
| Rate for Payer: Multiplan Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.88
|
| Rate for Payer: TriValley Medical Group Senior |
$111.88
|
| 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 |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OPTIC FORAMINA
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.53 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Adventist Health Commercial |
$114.40
|
| Rate for Payer: Cash Price |
$257.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$387.24
|
| Rate for Payer: Heritage Provider Network Senior |
$387.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.00
|
| Rate for Payer: Multiplan Commercial |
$429.00
|
|
|
HC ORBITS
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.29 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Cash Price |
$338.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Senior |
$509.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
|
|
HC ORBITS
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Adventist Health Commercial |
$150.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$402.48
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$517.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.33
|
| Rate for Payer: Blue Shield of California Commercial |
$166.80
|
| Rate for Payer: Blue Shield of California EPN |
$134.13
|
| Rate for Payer: Cash Price |
$338.85
|
| Rate for Payer: Cash Price |
$338.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$489.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Senior |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$489.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$135.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$466.11
|
| Rate for Payer: Heritage Provider Network Senior |
$466.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$61.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$359.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$564.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$135.12
|
| Rate for Payer: TriValley Medical Group Senior |
$135.12
|
| 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 |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
