|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
IP
|
$3,763.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$681.10 |
| Max. Negotiated Rate |
$2,822.25 |
| Rate for Payer: Adventist Health Commercial |
$752.60
|
| Rate for Payer: Cash Price |
$2,069.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,547.55
|
| Rate for Payer: Heritage Provider Network Senior |
$2,547.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.75
|
| Rate for Payer: Multiplan Commercial |
$2,822.25
|
|
|
HC REPOSITION CVP CATH W/FLUORO
|
Facility
|
OP
|
$3,763.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906812250
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$752.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,585.18
|
| 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 |
$3,531.00
|
| 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 |
$2,069.65
|
| Rate for Payer: Cash Price |
$2,069.65
|
| Rate for Payer: Cash Price |
$2,069.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,445.95
|
| 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 |
$2,329.30
|
| Rate for Payer: Heritage Provider Network Senior |
$2,427.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.38
|
| 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 |
$681.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,269.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$940.75
|
| 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 |
$2,822.25
|
| 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 REPOSITION CVP CATH W/FLUORO
|
Facility
|
IP
|
$4,081.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
906820089
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$738.66 |
| Max. Negotiated Rate |
$3,060.75 |
| Rate for Payer: Adventist Health Commercial |
$816.20
|
| Rate for Payer: Cash Price |
$2,244.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,762.84
|
| Rate for Payer: Heritage Provider Network Senior |
$2,762.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.25
|
| Rate for Payer: Multiplan Commercial |
$3,060.75
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$6,134.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,110.25 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,110.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,533.50
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$6,134.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$11,717.00 |
| Rate for Payer: Adventist Health Commercial |
$1,226.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,278.62
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,214.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,373.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,600.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,551.84
|
| Rate for Payer: Blue Shield of California EPN |
$8,451.82
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Cash Price |
$3,373.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,213.90
|
| Rate for Payer: Dignity Health Senior |
$5,213.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,796.95
|
| Rate for Payer: Heritage Provider Network Senior |
$3,796.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,925.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,110.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,533.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,293.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,293.80
|
| Rate for Payer: Multiplan Commercial |
$4,600.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,213.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,213.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,213.90
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$7,217.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906820234
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$11,717.00 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,857.49
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,958.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,969.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,412.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$10,551.84
|
| Rate for Payer: Blue Shield of California EPN |
$8,451.82
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,340.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,134.45
|
| Rate for Payer: Dignity Health Senior |
$6,134.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,467.32
|
| Rate for Payer: Heritage Provider Network Senior |
$4,467.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,442.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,306.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,804.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,051.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,051.90
|
| Rate for Payer: Multiplan Commercial |
$5,412.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,134.45
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$7,217.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906820234
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,306.28 |
| Max. Negotiated Rate |
$5,478.00 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,478.00
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,306.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,804.25
|
| Rate for Payer: Multiplan Commercial |
$5,412.75
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
OP
|
$18,264.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$3,652.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$12,547.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$10,045.20
|
| Rate for Payer: Cash Price |
$10,045.20
|
| Rate for Payer: Cash Price |
$10,045.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$11,871.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Senior |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,076.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,364.73
|
| Rate for Payer: Heritage Provider Network Senior |
$12,364.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$8,711.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,305.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,438.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,566.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,436.79
|
| Rate for Payer: Multiplan Commercial |
$13,698.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$6,571.39
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$6,047.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
IP
|
$18,264.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,305.78 |
| Max. Negotiated Rate |
$13,698.00 |
| Rate for Payer: Adventist Health Commercial |
$3,652.80
|
| Rate for Payer: Cash Price |
$10,045.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,364.73
|
| Rate for Payer: Heritage Provider Network Senior |
$12,364.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,305.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,566.00
|
| Rate for Payer: Multiplan Commercial |
$13,698.00
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
IP
|
$5,773.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$4,329.75 |
| Rate for Payer: Adventist Health Commercial |
$1,154.60
|
| Rate for Payer: Cash Price |
$3,175.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,908.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3,908.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,044.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.25
|
| Rate for Payer: Multiplan Commercial |
$4,329.75
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
OP
|
$5,773.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$4,959.00 |
| Rate for Payer: Adventist Health Commercial |
$1,154.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,085.67
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,966.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$3,175.15
|
| Rate for Payer: Cash Price |
$3,175.15
|
| Rate for Payer: Cash Price |
$3,175.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,752.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Senior |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,752.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,897.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,908.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3,908.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,753.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,044.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,332.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,651.35
|
| Rate for Payer: Multiplan Commercial |
$4,329.75
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,077.13
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,911.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$2,387.25 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Cash Price |
$1,750.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,186.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,004.00
|
| Rate for Payer: Cash Price |
$1,750.65
|
| Rate for Payer: Cash Price |
$1,750.65
|
| Rate for Payer: Cash Price |
$1,750.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,068.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Senior |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,882.11
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,518.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$576.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,164.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,371.46
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,145.24
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,053.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$3,531.00 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$783.58
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,007.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$952.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.18
|
| Rate for Payer: Dignity Health Senior |
$381.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$952.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$381.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$381.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$699.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$438.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$480.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$480.15
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Multiplan WC |
$607.16
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$527.47
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$485.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Vantage Medical Group Senior |
$381.07
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.35 |
| Max. Negotiated Rate |
$1,099.50 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$992.48
|
| Rate for Payer: Heritage Provider Network Senior |
$992.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$265.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.50
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,531.00
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Senior |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$647.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$353.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$815.28
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$509.75
|
| 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 |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$482.30
|
| 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 |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| 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 |
$353.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$339.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| 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 |
$556.50
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$266.97
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$245.68
|
| 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 REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$556.50 |
| Rate for Payer: Adventist Health Commercial |
$148.40
|
| Rate for Payer: Cash Price |
$408.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.33
|
| Rate for Payer: Heritage Provider Network Senior |
$502.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$556.50
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$585.75 |
| Rate for Payer: Adventist Health Commercial |
$156.20
|
| Rate for Payer: Cash Price |
$429.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$528.74
|
| Rate for Payer: Heritage Provider Network Senior |
$528.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.25
|
| Rate for Payer: Multiplan Commercial |
$585.75
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$156.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$536.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,959.00
|
| Rate for Payer: Cash Price |
$429.55
|
| Rate for Payer: Cash Price |
$429.55
|
| Rate for Payer: Cash Price |
$429.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$507.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Senior |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$507.02
|
| Rate for Payer: Heritage Provider Network Commercial |
$528.74
|
| Rate for Payer: Heritage Provider Network Senior |
$528.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$372.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$583.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$638.85
|
| Rate for Payer: Multiplan Commercial |
$585.75
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$281.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$258.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
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 REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
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 RESECTION/DEBRID PANCREAS
|
Facility
|
IP
|
$14,773.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,673.91 |
| Max. Negotiated Rate |
$11,079.75 |
| Rate for Payer: Adventist Health Commercial |
$2,954.60
|
| Rate for Payer: Cash Price |
$8,125.15
|
| Rate for Payer: Heritage Provider Network Commercial |
$10,001.32
|
| Rate for Payer: Heritage Provider Network Senior |
$10,001.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,673.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,693.25
|
| Rate for Payer: Multiplan Commercial |
$11,079.75
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
OP
|
$14,773.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$12,557.05 |
| Rate for Payer: Adventist Health Commercial |
$2,954.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$7,896.17
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$10,149.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,557.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,125.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,079.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,785.00
|
| 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 |
$8,125.15
|
| Rate for Payer: Cash Price |
$8,125.15
|
| Rate for Payer: Cash Price |
$8,125.15
|
| Rate for Payer: Cigna of CA HMO/PPO |
$9,602.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,557.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,557.05
|
| Rate for Payer: Dignity Health Senior |
$12,557.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9,144.49
|
| Rate for Payer: Heritage Provider Network Senior |
$9,144.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,607.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,046.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,673.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,693.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,341.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,341.10
|
| Rate for Payer: Multiplan Commercial |
$11,079.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$425.00
|
| Rate for Payer: TriValley Medical Group Senior |
$425.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,557.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,557.05
|
| Rate for Payer: Vantage Medical Group Senior |
$12,557.05
|
|
