|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$5,054.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$914.77 |
| Max. Negotiated Rate |
$3,790.50 |
| Rate for Payer: Adventist Health Commercial |
$1,010.80
|
| Rate for Payer: Cash Price |
$2,779.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,421.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,421.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$914.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.50
|
| Rate for Payer: Multiplan Commercial |
$3,790.50
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
IP
|
$5,215.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$3,911.25 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$943.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
OP
|
$5,215.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,582.70
|
| 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 |
$3,531.00
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Cash Price |
$2,868.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,389.75
|
| 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 |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| 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 |
$2,487.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$943.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| 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 |
$3,911.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,876.36
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,726.69
|
| 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 REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,055.63
|
| 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 |
$8,111.00
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| 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 |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| 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 |
$3,510.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,740.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| 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 |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,647.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,436.56
|
| 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 REPAIR TENDON/MUSCLE PRIM SNGL
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Cash Price |
$4,047.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$869.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,987.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,391.95
|
| Rate for Payer: Cash Price |
$2,391.95
|
| Rate for Payer: Cash Price |
$2,391.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,826.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Senior |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$295.06
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,944.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,944.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,074.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$787.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$371.78
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,564.77
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,439.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$787.17 |
| Max. Negotiated Rate |
$3,261.75 |
| Rate for Payer: Adventist Health Commercial |
$869.80
|
| Rate for Payer: Cash Price |
$2,391.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,944.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,944.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$787.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.25
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.67 |
| Max. Negotiated Rate |
$2,799.75 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,527.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,527.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,564.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,426.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,527.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,527.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,780.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,343.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,236.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$675.67 |
| Max. Negotiated Rate |
$2,799.75 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,527.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,527.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,564.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cash Price |
$2,053.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,426.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Senior |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$785.56
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,310.73
|
| Rate for Payer: Heritage Provider Network Senior |
$966.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$74.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,492.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$675.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$903.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.81
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$864.12
|
| Rate for Payer: TriValley Medical Group Senior |
$864.12
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$711.33 |
| Max. Negotiated Rate |
$2,947.50 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,660.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2,660.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.50
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,699.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,554.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Senior |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,973.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,432.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,750.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,486.99
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,171.18
|
| Rate for Payer: TriValley Medical Group Senior |
$2,171.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$6,053.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$7,634.30 |
| Rate for Payer: Adventist Health Commercial |
$1,210.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,158.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,270.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,791.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$3,329.15
|
| Rate for Payer: Cash Price |
$3,329.15
|
| Rate for Payer: Cash Price |
$3,329.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,934.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,270.57
|
| Rate for Payer: Dignity Health Senior |
$4,791.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,934.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,791.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,097.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,097.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,791.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,887.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,510.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,037.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,037.20
|
| Rate for Payer: Multiplan Commercial |
$4,539.75
|
| Rate for Payer: Multiplan WC |
$7,634.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,177.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,004.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,187.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,270.57
|
| Rate for Payer: Vantage Medical Group Senior |
$4,791.43
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,095.59 |
| Max. Negotiated Rate |
$4,539.75 |
| Rate for Payer: Adventist Health Commercial |
$1,210.60
|
| Rate for Payer: Cash Price |
$3,329.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,097.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,095.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.25
|
| Rate for Payer: Multiplan Commercial |
$4,539.75
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
IP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,159.31 |
| Max. Negotiated Rate |
$4,803.75 |
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,336.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4,336.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,159.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.25
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
OP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,400.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Cash Price |
$3,522.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,163.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,336.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4,336.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,055.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,159.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,304.52
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,120.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$10,943.70 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,478.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,290.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Senior |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,868.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,427.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,427.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,415.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,898.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,265.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,654.28
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,821.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,676.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$916.40 |
| Max. Negotiated Rate |
$3,797.25 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,427.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,427.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,265.75
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,478.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,290.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Senior |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,999.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,427.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,427.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,415.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,599.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,265.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,039.00
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,821.67
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,676.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$916.40 |
| Max. Negotiated Rate |
$3,797.25 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Cash Price |
$2,784.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,427.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,427.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,265.75
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
OP
|
$1,834.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$366.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,259.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$1,008.70
|
| Rate for Payer: Cash Price |
$1,008.70
|
| Rate for Payer: Cash Price |
$1,008.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,192.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Senior |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$777.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,241.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,241.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$874.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$979.99
|
| Rate for Payer: Multiplan Commercial |
$1,375.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$659.87
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$607.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
|
IP
|
$1,834.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$331.95 |
| Max. Negotiated Rate |
$1,375.50 |
| Rate for Payer: Adventist Health Commercial |
$366.80
|
| Rate for Payer: Cash Price |
$1,008.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,241.62
|
| Rate for Payer: Heritage Provider Network Senior |
$1,241.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$331.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$458.50
|
| Rate for Payer: Multiplan Commercial |
$1,375.50
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$608.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$575.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Senior |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.64
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.82
|
| Rate for Payer: Heritage Provider Network Senior |
$599.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$422.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$639.63
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$318.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$293.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.37 |
| Max. Negotiated Rate |
$664.50 |
| Rate for Payer: Adventist Health Commercial |
$177.20
|
| Rate for Payer: Cash Price |
$487.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$599.82
|
| Rate for Payer: Heritage Provider Network Senior |
$599.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.50
|
| Rate for Payer: Multiplan Commercial |
$664.50
|
|
