|
HC RENOGRAM WITH FLOW
|
Facility
OP
|
$2,459.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,844.25 |
| Rate for Payer: Adventist Health Commercial |
$491.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$424.44
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,689.33
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Blue Shield of California Commercial |
$910.80
|
| Rate for Payer: Blue Shield of California EPN |
$517.94
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Cash Price |
$1,106.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,598.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: Dignity Health Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,598.35
|
| Rate for Payer: EPIC Health Plan Medicare |
$675.33
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,522.12
|
| Rate for Payer: Heritage Provider Network Senior |
$1,522.12
|
| Rate for Payer: Humana Medicare |
$675.33
|
| Rate for Payer: IEHP Medi-Cal |
$301.00
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,283.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$796.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$614.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$850.92
|
| Rate for Payer: Multiplan Commercial |
$1,844.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$742.86
|
| Rate for Payer: TriValley Medical Group Senior |
$675.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
IP
|
$10,036.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,816.52 |
| Max. Negotiated Rate |
$7,527.00 |
| Rate for Payer: Adventist Health Commercial |
$2,007.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,894.73
|
| Rate for Payer: Cash Price |
$4,516.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,794.37
|
| Rate for Payer: Heritage Provider Network Senior |
$6,794.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,509.00
|
| Rate for Payer: Multiplan Commercial |
$7,527.00
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
OP
|
$10,036.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$13,407.80 |
| Rate for Payer: Adventist Health Commercial |
$2,007.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,894.73
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$4,516.20
|
| Rate for Payer: Cash Price |
$4,516.20
|
| Rate for Payer: Cash Price |
$4,516.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,523.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: Dignity Health Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,938.53
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,794.37
|
| Rate for Payer: Heritage Provider Network Senior |
$6,794.37
|
| Rate for Payer: Humana Medicare |
$8,938.53
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,837.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,816.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,547.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,509.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,262.55
|
| Rate for Payer: Multiplan Commercial |
$7,527.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,644.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,353.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
OP
|
$2,515.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.22 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$503.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,727.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,634.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: Dignity Health Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.71
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,702.66
|
| Rate for Payer: Humana Medicare |
$784.71
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,212.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.73
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$913.20
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$840.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
IP
|
$2,515.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$455.22 |
| Max. Negotiated Rate |
$1,886.25 |
| Rate for Payer: Adventist Health Commercial |
$503.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,727.80
|
| Rate for Payer: Cash Price |
$1,131.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.66
|
| Rate for Payer: Heritage Provider Network Senior |
$1,702.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.75
|
| Rate for Payer: Multiplan Commercial |
$1,886.25
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
IP
|
$11,666.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,111.55 |
| Max. Negotiated Rate |
$8,749.50 |
| Rate for Payer: Adventist Health Commercial |
$2,333.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,014.54
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,897.88
|
| Rate for Payer: Heritage Provider Network Senior |
$7,897.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,111.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,916.50
|
| Rate for Payer: Multiplan Commercial |
$8,749.50
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
OP
|
$11,666.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$12,484.56 |
| Rate for Payer: Adventist Health Commercial |
$2,333.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$8,014.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Cash Price |
$5,249.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,582.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: Dignity Health Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,582.90
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,323.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,897.88
|
| Rate for Payer: Heritage Provider Network Senior |
$7,897.88
|
| Rate for Payer: Humana Medicare |
$8,323.04
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$5,623.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,111.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,821.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,916.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,487.03
|
| Rate for Payer: Multiplan Commercial |
$8,749.50
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,235.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,897.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,760.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,326.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,220.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
IP
|
$6,033.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,091.97 |
| Max. Negotiated Rate |
$4,524.75 |
| Rate for Payer: Adventist Health Commercial |
$1,206.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,144.67
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,084.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,084.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,091.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,508.25
|
| Rate for Payer: Multiplan Commercial |
$4,524.75
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
OP
|
$6,033.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,206.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,144.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cash Price |
$2,714.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,921.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,084.34
|
| Rate for Payer: Heritage Provider Network Senior |
$4,084.34
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,907.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,091.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,508.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$4,524.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,190.58
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,015.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
OP
|
$8,303.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$676.04 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,660.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,704.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,156.16
|
| Rate for Payer: Blue Shield of California EPN |
$4,873.86
|
| Rate for Payer: Cash Price |
$3,736.35
|
| Rate for Payer: Cash Price |
$3,736.35
|
| Rate for Payer: Cash Price |
$3,736.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,396.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,139.56
|
| Rate for Payer: Heritage Provider Network Senior |
$4,974.38
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$676.04
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$7,684.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,502.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$6,227.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,448.63
|
| Rate for Payer: TriValley Medical Group Senior |
$4,448.63
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$9,520.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$8,039.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
IP
|
$8,303.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,502.84 |
| Max. Negotiated Rate |
$6,227.25 |
| Rate for Payer: Adventist Health Commercial |
$1,660.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,704.16
|
| Rate for Payer: Cash Price |
$3,736.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,621.13
|
| Rate for Payer: Heritage Provider Network Senior |
$5,621.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,502.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,075.75
|
| Rate for Payer: Multiplan Commercial |
$6,227.25
|
|
|
HC REPAIR FOOT TENDON
|
Facility
OP
|
$4,626.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$925.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,178.06
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,006.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,131.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,131.80
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,229.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$3,469.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,679.70
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,545.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR FOOT TENDON
|
Facility
IP
|
$4,626.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$837.31 |
| Max. Negotiated Rate |
$3,469.50 |
| Rate for Payer: Adventist Health Commercial |
$925.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,178.06
|
| Rate for Payer: Cash Price |
$2,081.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,131.80
|
| Rate for Payer: Heritage Provider Network Senior |
$3,131.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$837.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.50
|
| Rate for Payer: Multiplan Commercial |
$3,469.50
|
|
|
HC REPAIR HAND JOINT
|
Facility
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,374.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: Dignity Health Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,044.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Humana Medicare |
$4,044.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,760.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,772.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,095.70
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,326.40
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,220.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REPAIR HAND JOINT
|
Facility
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$661.19 |
| Max. Negotiated Rate |
$2,739.75 |
| Rate for Payer: Adventist Health Commercial |
$730.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,509.61
|
| Rate for Payer: Cash Price |
$1,643.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,473.08
|
| Rate for Payer: Heritage Provider Network Senior |
$2,473.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$661.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Multiplan Commercial |
$2,739.75
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
OP
|
$7,094.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,418.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,873.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,322.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,611.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,754.88
|
| Rate for Payer: Dignity Health Senior |
$4,322.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,322.62
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,802.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,802.64
|
| Rate for Payer: Humana Medicare |
$4,322.62
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,322.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,419.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,284.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,446.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,446.50
|
| Rate for Payer: Multiplan Commercial |
$5,320.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,575.83
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,370.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,483.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,754.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4,322.62
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
IP
|
$7,094.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,284.01 |
| Max. Negotiated Rate |
$5,320.50 |
| Rate for Payer: Adventist Health Commercial |
$1,418.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,873.58
|
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,802.64
|
| Rate for Payer: Heritage Provider Network Senior |
$4,802.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,284.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,773.50
|
| Rate for Payer: Multiplan Commercial |
$5,320.50
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
OP
|
$9,684.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,795.32 |
| Rate for Payer: Adventist Health Commercial |
$1,936.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,652.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,530.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,436.00
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,294.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,183.23
|
| Rate for Payer: Dignity Health Senior |
$6,530.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,294.60
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,530.21
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,556.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,556.07
|
| Rate for Payer: Humana Medicare |
$6,530.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6,530.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,667.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,752.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,705.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,228.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,228.06
|
| Rate for Payer: Multiplan Commercial |
$7,263.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,516.26
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,235.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,795.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,183.23
|
| Rate for Payer: Vantage Medical Group Senior |
$6,530.21
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
IP
|
$9,684.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,752.80 |
| Max. Negotiated Rate |
$7,263.00 |
| Rate for Payer: Adventist Health Commercial |
$1,936.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,652.91
|
| Rate for Payer: Cash Price |
$4,357.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,556.07
|
| Rate for Payer: Heritage Provider Network Senior |
$6,556.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,752.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,421.00
|
| Rate for Payer: Multiplan Commercial |
$7,263.00
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
IP
|
$2,914.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$2,185.50 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
OP
|
$2,914.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,894.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,404.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,058.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
OP
|
$2,914.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,894.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: Dignity Health Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$687.44
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Humana Medicare |
$687.44
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,404.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$811.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$866.17
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,058.07
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$973.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
IP
|
$2,914.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.43 |
| Max. Negotiated Rate |
$2,185.50 |
| Rate for Payer: Adventist Health Commercial |
$582.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,001.92
|
| Rate for Payer: Cash Price |
$1,311.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,972.78
|
| Rate for Payer: Heritage Provider Network Senior |
$1,972.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$527.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.50
|
| Rate for Payer: Multiplan Commercial |
$2,185.50
|
|
