|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$6,419.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.84 |
| Max. Negotiated Rate |
$4,814.25 |
| Rate for Payer: Adventist Health Commercial |
$1,283.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,133.84
|
| Rate for Payer: Cash Price |
$2,888.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,345.66
|
| Rate for Payer: Heritage Provider Network Senior |
$4,345.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,161.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.75
|
| Rate for Payer: Multiplan Commercial |
$4,814.25
|
|
|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
OP
|
$6,419.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,161.84 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,283.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,966.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,049.03
|
| Rate for Payer: Blue Shield of California EPN |
$2,426.38
|
| Rate for Payer: Cash Price |
$2,888.55
|
| Rate for Payer: Cash Price |
$2,888.55
|
| Rate for Payer: Cash Price |
$2,888.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,172.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,345.66
|
| Rate for Payer: Heritage Provider Network Senior |
$4,345.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,061.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,161.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,604.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,814.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,851.40
|
| Rate for Payer: TriValley Medical Group Senior |
$3,851.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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 |
$2,688.03 |
| Max. Negotiated Rate |
$11,976.10 |
| Rate for Payer: Adventist Health Commercial |
$2,970.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,177.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,136.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,054.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,613.68
|
| 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 |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,613.89
|
| 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) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,083.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,688.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,755.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,712.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan Commercial |
$11,138.25
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,910.60
|
| Rate for Payer: TriValley Medical Group Senior |
$8,910.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
IP
|
$14,851.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,688.03 |
| Max. Negotiated Rate |
$11,138.25 |
| Rate for Payer: Adventist Health Commercial |
$2,970.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,564.04
|
| Rate for Payer: Cash Price |
$6,682.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,054.13
|
| Rate for Payer: Heritage Provider Network Senior |
$10,054.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,688.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,712.75
|
| Rate for Payer: Multiplan Commercial |
$11,138.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$10,318.17
|
| 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 Foundation Hospitals 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 |
$2,899.98 |
| Max. Negotiated Rate |
$12,016.50 |
| Rate for Payer: Adventist Health Commercial |
$3,204.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$9,901.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,610.45
|
| Rate for Payer: Blue Shield of California EPN |
$6,056.32
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| 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) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$7,642.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,899.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,005.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$12,016.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,613.20
|
| Rate for Payer: TriValley Medical Group Senior |
$9,613.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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 |
$2,173.09 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$2,401.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,419.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,702.85
|
| Rate for Payer: Blue Shield of California EPN |
$4,538.27
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| 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) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$5,726.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,173.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,001.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$9,004.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$7,203.60
|
| Rate for Payer: TriValley Medical Group Senior |
$7,203.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
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: Aetna of CA Non-Gatekeeper |
$7,731.86
|
| 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 Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$8,687.56
|
| 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 Foundation Hospitals 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 OPEN TREAT TALUS FRACTURE
|
Facility
|
OP
|
$13,490.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,441.69 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$2,698.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,336.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,407.75
|
| Rate for Payer: Blue Shield of California EPN |
$5,099.22
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| 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) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$6,434.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,441.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,372.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$10,117.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$8,094.00
|
| Rate for Payer: TriValley Medical Group Senior |
$8,094.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.38 |
| Max. Negotiated Rate |
$822.00 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$705.82
|
| 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 Foundation Hospitals Medi-Cal |
$198.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.38 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$677.33
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$520.60
|
| Rate for Payer: Blue Shield of California EPN |
$414.29
|
| 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 Medicare Advantage |
$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: Kaiser Foundation Hospitals Commercial |
$522.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$274.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$767.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Senior |
$657.60
|
| 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 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 Non-Gatekeeper |
$421.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$341.14
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$402.38
|
| Rate for Payer: EPIC Health Plan Medicare |
$111.93
|
| 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 |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$325.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$111.93
|
| Rate for Payer: TriValley Medical Group Senior |
$111.93
|
| 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 |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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: Aetna of CA Non-Gatekeeper |
$439.21
|
| 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 Foundation Hospitals 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
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$345.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$296.24
|
| 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 Foundation Hospitals Medi-Cal |
$83.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$284.28
|
| 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 |
$185.89
|
| 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 Medicare Advantage |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$284.74
|
| Rate for Payer: Heritage Provider Network Senior |
$284.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$219.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$640.14
|
| 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 Foundation Hospitals Medi-Cal |
$179.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.50
|
| Rate for Payer: Multiplan Commercial |
$745.50
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: Adventist Health Commercial |
$198.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$614.29
|
| 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 Medicare Advantage |
$844.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.46
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.29
|
| Rate for Payer: Heritage Provider Network Senior |
$615.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$474.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/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 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: Aetna of CA Non-Gatekeeper |
$2,844.55
|
| 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 Foundation Hospitals 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 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 |
$799.48 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$883.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,729.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,098.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,669.63
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,289.25
|
| 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) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,106.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$799.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,632.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,104.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$3,312.75
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,650.20
|
| Rate for Payer: TriValley Medical Group Senior |
$2,650.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
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: Aetna of CA Non-Gatekeeper |
$302.04
|
| 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 Foundation Hospitals 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 |
$84.89 |
| Max. Negotiated Rate |
$351.75 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$289.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.59
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$276.71
|
| Rate for Payer: EPIC Health Plan Medicare |
$134.46
|
| 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) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$223.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$134.46
|
| Rate for Payer: TriValley Medical Group Senior |
$134.46
|
| 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 |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC OPIATES CONF & ID
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$221.86
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$184.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.19
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$233.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$222.22
|
| Rate for Payer: Heritage Provider Network Commercial |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$184.46
|
| Rate for Payer: Heritage Provider Network Senior |
$222.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$142.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$208.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$179.50
|
| 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: United Healthcare Navigate/Select/Select+ |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| 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 Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
|
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: Aetna of CA Non-Gatekeeper |
$231.20
|
| 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 Foundation Hospitals 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
|
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: Aetna of CA Non-Gatekeeper |
$368.37
|
| 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 Foundation Hospitals Medi-Cal |
$103.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.00
|
| Rate for Payer: Multiplan Commercial |
$429.00
|
|
