|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
|
OP
|
$879.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$603.87
|
| 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 |
$4,959.00
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$571.35
|
| 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 |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| 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 |
$419.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| 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 |
$659.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$316.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$291.04
|
| 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 SCALP/ARM/L
|
Facility
|
IP
|
$879.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.10 |
| Max. Negotiated Rate |
$659.25 |
| Rate for Payer: Adventist Health Commercial |
$175.80
|
| Rate for Payer: Cash Price |
$483.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$595.08
|
| Rate for Payer: Heritage Provider Network Senior |
$595.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.75
|
| Rate for Payer: Multiplan Commercial |
$659.25
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,437.20
|
| 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 |
$1,150.60
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,359.80
|
| 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 |
$1,416.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,416.28
|
| 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 |
$997.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| 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 |
$1,569.00
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$752.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$692.66
|
| 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 2.6-7.5 CM EYELID, NOS
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$378.65 |
| Max. Negotiated Rate |
$1,569.00 |
| Rate for Payer: Adventist Health Commercial |
$418.40
|
| Rate for Payer: Cash Price |
$1,150.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,416.28
|
| Rate for Payer: Heritage Provider Network Senior |
$1,416.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Multiplan Commercial |
$1,569.00
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$687.75 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
|
|
HC REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$183.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$629.98
|
| 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 |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cash Price |
$504.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$596.05
|
| 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 |
$620.81
|
| Rate for Payer: Heritage Provider Network Senior |
$620.81
|
| 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 |
$437.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.25
|
| 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 |
$687.75
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$329.94
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$303.62
|
| 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 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
OP
|
$886.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
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 |
$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 |
$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 |
$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 |
$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 |
$777.77
|
| 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 |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.50
|
| 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 |
$664.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| 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 |
$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 2.6-7.5 CM, SCALP,ARMS
|
Facility
|
IP
|
$886.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
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
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
|
OP
|
$1,311.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$900.66
|
| 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 |
$4,959.00
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$852.15
|
| 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 |
$887.55
|
| Rate for Payer: Heritage Provider Network Senior |
$887.55
|
| 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 |
$625.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$894.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| 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 |
$983.25
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$471.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$434.07
|
| 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 2.6 - 7.5 CM, TRUNK
|
Facility
|
IP
|
$1,311.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.29 |
| Max. Negotiated Rate |
$983.25 |
| Rate for Payer: Adventist Health Commercial |
$262.20
|
| Rate for Payer: Cash Price |
$721.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$887.55
|
| Rate for Payer: Heritage Provider Network Senior |
$887.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$237.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$327.75
|
| Rate for Payer: Multiplan Commercial |
$983.25
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.64 |
| Max. Negotiated Rate |
$993.00 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$896.35
|
| Rate for Payer: Heritage Provider Network Senior |
$896.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.00
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$264.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$909.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,125.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$728.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$993.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cash Price |
$728.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$860.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,125.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,125.40
|
| Rate for Payer: Dignity Health Senior |
$1,125.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$896.35
|
| Rate for Payer: Heritage Provider Network Senior |
$896.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$631.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$926.80
|
| Rate for Payer: Multiplan Commercial |
$993.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$476.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$438.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,125.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,125.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,125.40
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
IP
|
$1,420.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.02 |
| Max. Negotiated Rate |
$1,065.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$961.34
|
| Rate for Payer: Heritage Provider Network Senior |
$961.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
|
OP
|
$1,420.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$284.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$975.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$781.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,065.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cash Price |
$781.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$923.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,207.00
|
| Rate for Payer: Dignity Health Senior |
$1,207.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$961.34
|
| Rate for Payer: Heritage Provider Network Senior |
$961.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$677.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$994.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$994.00
|
| Rate for Payer: Multiplan Commercial |
$1,065.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$510.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$470.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,207.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,207.00
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$765.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$690.54
|
| Rate for Payer: Heritage Provider Network Senior |
$690.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$765.00
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$204.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$700.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$867.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cash Price |
$561.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$663.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$867.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$867.00
|
| Rate for Payer: Dignity Health Senior |
$867.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$690.54
|
| Rate for Payer: Heritage Provider Network Senior |
$690.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$486.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$714.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$714.00
|
| Rate for Payer: Multiplan Commercial |
$765.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$367.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$337.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$867.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$867.00
|
| Rate for Payer: Vantage Medical Group Senior |
$867.00
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,741.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,435.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,321.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,741.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,111.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Senior |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,033.48
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,338.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,562.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,435.60
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,321.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC REP EXT TENDON/FINGER/PRIM OR
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Cash Price |
$2,194.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
IP
|
$1,104.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$199.82 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$747.41
|
| Rate for Payer: Heritage Provider Network Senior |
$747.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
|
OP
|
$1,104.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$220.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$758.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$607.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$828.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cash Price |
$607.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$717.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$938.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$938.40
|
| Rate for Payer: Dignity Health Senior |
$938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$747.41
|
| Rate for Payer: Heritage Provider Network Senior |
$747.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$526.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$772.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$772.80
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$397.22
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$365.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$938.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$938.40
|
| Rate for Payer: Vantage Medical Group Senior |
$938.40
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
OP
|
$8,275.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$12,964.88 |
| Rate for Payer: Adventist Health Commercial |
$1,655.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,684.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$4,551.25
|
| Rate for Payer: Cash Price |
$4,551.25
|
| Rate for Payer: Cash Price |
$4,551.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,378.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Senior |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,378.75
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,137.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,602.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,602.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,947.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,357.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,068.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,252.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,252.63
|
| Rate for Payer: Multiplan Commercial |
$6,206.25
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,977.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,739.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
|
IP
|
$8,275.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,497.78 |
| Max. Negotiated Rate |
$6,206.25 |
| Rate for Payer: Adventist Health Commercial |
$1,655.00
|
| Rate for Payer: Cash Price |
$4,551.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,602.18
|
| Rate for Payer: Heritage Provider Network Senior |
$5,602.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,497.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,068.75
|
| Rate for Payer: Multiplan Commercial |
$6,206.25
|
|
|
HC REP INCARCERATED HERNIA REDUCT
|
Facility
|
IP
|
$13,120.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,374.72 |
| Max. Negotiated Rate |
$9,840.00 |
| Rate for Payer: Adventist Health Commercial |
$2,624.00
|
| Rate for Payer: Cash Price |
$7,216.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8,882.24
|
| Rate for Payer: Heritage Provider Network Senior |
$8,882.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,374.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,280.00
|
| Rate for Payer: Multiplan Commercial |
$9,840.00
|
|
