|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
IP
|
$3,617.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$2,712.75 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
IP
|
$3,617.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$2,712.75 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
OP
|
$3,617.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,351.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.39
|
| Rate for Payer: Dignity Health Senior |
$784.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$784.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Humana Medicare |
$784.90
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,743.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$926.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$988.97
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,313.33
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,208.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.39
|
| Rate for Payer: Vantage Medical Group Senior |
$784.90
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
IP
|
$3,617.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$654.68 |
| Max. Negotiated Rate |
$2,712.75 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,448.71
|
| Rate for Payer: Heritage Provider Network Senior |
$2,448.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
OP
|
$3,617.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.21 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$723.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,484.88
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cash Price |
$1,627.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,351.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: Dignity Health Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,001.01
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,238.92
|
| Rate for Payer: Heritage Provider Network Senior |
$2,461.24
|
| Rate for Payer: Humana Medicare |
$2,001.01
|
| Rate for Payer: IEHP Medi-Cal |
$179.21
|
| Rate for Payer: IEHP Medicare Advantage |
$2,001.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,801.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,361.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$904.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,521.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,521.27
|
| Rate for Payer: Multiplan Commercial |
$2,712.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,201.11
|
| Rate for Payer: TriValley Medical Group Senior |
$2,201.11
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
IP
|
$5,976.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,081.66 |
| Max. Negotiated Rate |
$4,482.00 |
| Rate for Payer: Adventist Health Commercial |
$1,195.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,105.51
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,045.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,045.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,494.00
|
| Rate for Payer: Multiplan Commercial |
$4,482.00
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
OP
|
$5,976.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$7,246.18 |
| Rate for Payer: Adventist Health Commercial |
$1,195.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,105.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,830.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cash Price |
$2,689.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,884.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,313.87
|
| Rate for Payer: Dignity Health Senior |
$4,830.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,884.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,830.79
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,045.75
|
| Rate for Payer: Heritage Provider Network Senior |
$4,045.75
|
| Rate for Payer: Humana Medicare |
$4,830.79
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,830.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,880.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,081.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,700.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,494.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,086.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,086.80
|
| Rate for Payer: Multiplan Commercial |
$4,482.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,169.89
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,996.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,246.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,313.87
|
| Rate for Payer: Vantage Medical Group Senior |
$4,830.79
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
OP
|
$9,418.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,883.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,470.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,121.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,375.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,375.99
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,539.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,704.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$7,063.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,419.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,146.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
IP
|
$9,418.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,704.66 |
| Max. Negotiated Rate |
$7,063.50 |
| Rate for Payer: Adventist Health Commercial |
$1,883.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,470.17
|
| Rate for Payer: Cash Price |
$4,238.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,375.99
|
| Rate for Payer: Heritage Provider Network Senior |
$6,375.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,704.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.50
|
| Rate for Payer: Multiplan Commercial |
$7,063.50
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
IP
|
$8,648.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,565.29 |
| Max. Negotiated Rate |
$6,486.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
OP
|
$8,648.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$10,299.10 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$5,088.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: Dignity Health Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,866.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Humana Medicare |
$6,866.07
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,168.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,101.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,651.25
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,140.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,889.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
OP
|
$8,648.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,505.00
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: Dignity Health Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,982.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Humana Medicare |
$3,982.55
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$4,168.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,699.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,018.01
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,140.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,889.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
IP
|
$8,648.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,565.29 |
| Max. Negotiated Rate |
$6,486.00 |
| Rate for Payer: Adventist Health Commercial |
$1,729.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,941.18
|
| Rate for Payer: Cash Price |
$3,891.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,854.70
|
| Rate for Payer: Heritage Provider Network Senior |
$5,854.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,565.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,162.00
|
| Rate for Payer: Multiplan Commercial |
$6,486.00
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
IP
|
$1,679.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.90 |
| Max. Negotiated Rate |
$1,259.25 |
| Rate for Payer: Adventist Health Commercial |
$335.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,153.47
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,136.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,136.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.75
|
| Rate for Payer: Multiplan Commercial |
$1,259.25
|
|
|
HC REP COM 1.1-2.5 CM, EYELIDS,NO
|
Facility
OP
|
$1,679.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
900501043
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.90 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$335.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,153.47
|
| 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 |
$5,505.00
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Cash Price |
$755.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,091.35
|
| 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 |
$1,136.68
|
| Rate for Payer: Heritage Provider Network Senior |
$1,136.68
|
| 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 |
$809.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.75
|
| 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 |
$1,259.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$609.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$560.95
|
| 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 REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
IP
|
$810.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
|
|
HC REP COM 1.1-2.5 CM, FOREHEAD,C
|
Facility
OP
|
$810.00
|
|
|
Service Code
|
CPT 13131
|
| Hospital Charge Code |
900501041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$526.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: Dignity Health Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$498.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| Rate for Payer: Humana Medicare |
$498.20
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$390.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.73
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$270.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
IP
|
$804.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$603.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| Rate for Payer: Multiplan Commercial |
$603.00
|
|
|
HC REP COM 1.1-2.5 CM SCALP/ARM/L
|
Facility
OP
|
$804.00
|
|
|
Service Code
|
CPT 13120
|
| Hospital Charge Code |
900501320
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.52 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$160.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$552.35
|
| 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 |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cash Price |
$361.80
|
| Rate for Payer: Cigna of CA HMO/PPO |
$522.60
|
| 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 |
$544.31
|
| Rate for Payer: Heritage Provider Network Senior |
$544.31
|
| 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 |
$387.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.00
|
| 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 |
$603.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$291.93
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$268.62
|
| 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 REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
IP
|
$1,915.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.62 |
| Max. Negotiated Rate |
$1,436.25 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,315.60
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,296.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,296.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.75
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
|
|
HC REP COM 2.6-7.5 CM EYELID, NOS
|
Facility
OP
|
$1,915.00
|
|
|
Service Code
|
CPT 13152
|
| Hospital Charge Code |
900501329
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.62 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,315.60
|
| 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 |
$5,505.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,244.75
|
| 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 |
$1,296.46
|
| Rate for Payer: Heritage Provider Network Senior |
$1,296.46
|
| 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 |
$923.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$478.75
|
| 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 |
$1,436.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$695.34
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$639.80
|
| 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 REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
OP
|
$839.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$576.39
|
| 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 |
$5,505.00
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$545.35
|
| 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 |
$568.00
|
| Rate for Payer: Heritage Provider Network Senior |
$568.00
|
| 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 |
$404.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| 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 |
$629.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$304.64
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$280.31
|
| 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 REP COM 2.6-7.5 CM, FOREHEAD,C
|
Facility
IP
|
$839.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
900501042
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$629.25 |
| Rate for Payer: Adventist Health Commercial |
$167.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$576.39
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$568.00
|
| Rate for Payer: Heritage Provider Network Senior |
$568.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.75
|
| Rate for Payer: Multiplan Commercial |
$629.25
|
|
|
HC REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
OP
|
$810.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| 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 |
$5,505.00
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$526.50
|
| 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 |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| 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 |
$390.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| 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 |
$607.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$294.11
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$270.62
|
| 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 REP COM 2.6-7.5 CM, SCALP,ARMS
|
Facility
IP
|
$810.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
900501040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.61 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Adventist Health Commercial |
$162.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$556.47
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$548.37
|
| Rate for Payer: Heritage Provider Network Senior |
$548.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
|
