|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$812.40
|
| Rate for Payer: Heritage Provider Network Senior |
$812.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
|
|
HC REP COM 2.6 - 7.5 CM, TRUNK
|
Facility
OP
|
$1,200.00
|
|
|
Service Code
|
CPT 13101
|
| Hospital Charge Code |
900501672
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.40
|
| 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 |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$780.00
|
| 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 |
$812.40
|
| Rate for Payer: Heritage Provider Network Senior |
$812.40
|
| 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 |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| 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 |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$435.72
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$400.92
|
| 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 EA ADD 5 CM OR LT,SCAL
|
Facility
IP
|
$1,212.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.37 |
| Max. Negotiated Rate |
$909.00 |
| Rate for Payer: Adventist Health Commercial |
$242.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$832.64
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.52
|
| Rate for Payer: Heritage Provider Network Senior |
$820.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.00
|
| Rate for Payer: Multiplan Commercial |
$909.00
|
|
|
HC REP COM EA ADD 5 CM OR LT,SCAL
|
Facility
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 13122
|
| Hospital Charge Code |
900501321
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.37 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$242.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$832.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,030.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$666.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$909.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$787.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,030.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,030.20
|
| Rate for Payer: Dignity Health Senior |
$1,030.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$820.52
|
| Rate for Payer: Heritage Provider Network Senior |
$820.52
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$584.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.00
|
| Rate for Payer: Multiplan Commercial |
$909.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$440.08
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$404.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,030.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,030.20
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
IP
|
$1,300.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Adventist Health Commercial |
$260.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.10
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.10
|
| Rate for Payer: Heritage Provider Network Senior |
$880.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.00
|
| Rate for Payer: Multiplan Commercial |
$975.00
|
|
|
HC REP COM EA ADD'L 5 CM OR LT
|
Facility
OP
|
$1,300.00
|
|
|
Service Code
|
CPT 13133
|
| Hospital Charge Code |
900501240
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$235.30 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$260.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$893.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,105.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$715.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$975.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$845.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,105.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,105.00
|
| Rate for Payer: Dignity Health Senior |
$1,105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$880.10
|
| Rate for Payer: Heritage Provider Network Senior |
$880.10
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$626.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$325.00
|
| Rate for Payer: Multiplan Commercial |
$975.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$472.03
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$434.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,105.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,105.00
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
OP
|
$934.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$641.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$793.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$513.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$700.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$607.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$793.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$793.90
|
| Rate for Payer: Dignity Health Senior |
$793.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$632.32
|
| Rate for Payer: Heritage Provider Network Senior |
$632.32
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$450.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.50
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$339.14
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$312.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$793.90
|
| Rate for Payer: Vantage Medical Group Senior |
$793.90
|
|
|
HC REP COM TRUNK, EA ADD 5CM
|
Facility
IP
|
$934.00
|
|
|
Service Code
|
CPT 13102
|
| Hospital Charge Code |
900501763
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$700.50 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$641.66
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$632.32
|
| Rate for Payer: Heritage Provider Network Senior |
$632.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.50
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
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 |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| 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 |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| 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 |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| 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 |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REP EXT TEND HAND PRI/SEC
|
Facility
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26410
|
| Hospital Charge Code |
900501074
|
|
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 REP EXT TENDON/FINGER/PRIM OR
|
Facility
IP
|
$3,653.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
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 REP EXT TENDON/FINGER/PRIM OR
|
Facility
OP
|
$3,653.00
|
|
|
Service Code
|
CPT 26418
|
| Hospital Charge Code |
900501232
|
|
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 |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| 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 |
$3,012.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: Dignity Health Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,008.09
|
| 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 |
$2,008.09
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| 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 |
$2,369.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$913.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,530.19
|
| 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 |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
OP
|
$1,011.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.99 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$694.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$859.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$556.05
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$758.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$657.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$859.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$859.35
|
| Rate for Payer: Dignity Health Senior |
$859.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.45
|
| Rate for Payer: Heritage Provider Network Senior |
$684.45
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$487.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$367.09
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$337.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$859.35
|
| Rate for Payer: Vantage Medical Group Senior |
$859.35
|
|
|
HC REP FACE COM EA ADDL 5CM OR LT
|
Facility
IP
|
$1,011.00
|
|
|
Service Code
|
CPT 13153
|
| Hospital Charge Code |
900501490
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$182.99 |
| Max. Negotiated Rate |
$758.25 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$694.56
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$684.45
|
| Rate for Payer: Heritage Provider Network Senior |
$684.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
IP
|
$7,575.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,371.08 |
| Max. Negotiated Rate |
$5,681.25 |
| Rate for Payer: Adventist Health Commercial |
$1,515.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,204.02
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,128.28
|
| Rate for Payer: Heritage Provider Network Senior |
$5,128.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,893.75
|
| Rate for Payer: Multiplan Commercial |
$5,681.25
|
|
|
HC REP HAND/FOOT NERVE,ULNAR MOTO
|
Facility
OP
|
$7,575.00
|
|
|
Service Code
|
CPT 64836
|
| Hospital Charge Code |
900501556
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$15,813.78 |
| Rate for Payer: Adventist Health Commercial |
$1,515.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$3,728.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,204.02
|
| 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: Blue Shield of California Commercial |
$4,704.08
|
| Rate for Payer: Blue Shield of California EPN |
$4,446.52
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Cash Price |
$3,408.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,923.75
|
| 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 |
$4,545.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$8,323.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,688.92
|
| Rate for Payer: Heritage Provider Network Senior |
$10,237.34
|
| Rate for Payer: Humana Medicare |
$8,323.04
|
| Rate for Payer: IEHP Medi-Cal |
$157.98
|
| Rate for Payer: IEHP Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$15,813.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,821.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,893.75
|
| 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 |
$5,681.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$9,155.34
|
| Rate for Payer: TriValley Medical Group Senior |
$9,155.34
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$11,566.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$9,766.00
|
| 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 REP INCARCERATED HERNIA REDUCT
|
Facility
OP
|
$11,239.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$2,247.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,857.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,721.19
|
| 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 |
$5,057.55
|
| Rate for Payer: Cash Price |
$5,057.55
|
| Rate for Payer: Cash Price |
$5,057.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$7,305.35
|
| 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 |
$7,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7,608.80
|
| 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 |
$5,417.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,100.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,809.75
|
| 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 |
$8,429.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$4,080.88
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$3,754.95
|
| 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 REP INCARCERATED HERNIA REDUCT
|
Facility
IP
|
$11,239.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
900501638
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,034.26 |
| Max. Negotiated Rate |
$8,429.25 |
| Rate for Payer: Adventist Health Commercial |
$2,247.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,721.19
|
| Rate for Payer: Cash Price |
$5,057.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,608.80
|
| Rate for Payer: Heritage Provider Network Senior |
$7,608.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,034.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,809.75
|
| Rate for Payer: Multiplan Commercial |
$8,429.25
|
|
|
HC REP INT WNDS 7.6-12.5CM
|
Facility
OP
|
$922.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.41
|
| 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 |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna of CA HMO/PPO |
$599.30
|
| 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 |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| 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 |
$444.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$925.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| 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 |
$691.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$334.78
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$308.04
|
| 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 INT WNDS 7.6-12.5CM
|
Facility
IP
|
$922.00
|
|
|
Service Code
|
CPT 12044
|
| Hospital Charge Code |
900501231
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$691.50 |
| Rate for Payer: Adventist Health Commercial |
$184.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$633.41
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.19
|
| Rate for Payer: Heritage Provider Network Senior |
$624.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.50
|
| Rate for Payer: Multiplan Commercial |
$691.50
|
|
|
HC REP INT WNDS FACE 7.6-12.5CM
|
Facility
OP
|
$1,323.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.46 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$264.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$2,869.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$908.90
|
| 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 |
$595.35
|
| Rate for Payer: Cash Price |
$595.35
|
| Rate for Payer: Cash Price |
$595.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$859.95
|
| 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 |
$895.67
|
| Rate for Payer: Heritage Provider Network Senior |
$895.67
|
| 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 |
$637.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$587.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.75
|
| 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 |
$992.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$480.38
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$442.01
|
| 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 INT WNDS FACE 7.6-12.5CM
|
Facility
IP
|
$1,323.00
|
|
|
Service Code
|
CPT 12054
|
| Hospital Charge Code |
900501038
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.46 |
| Max. Negotiated Rate |
$992.25 |
| Rate for Payer: Adventist Health Commercial |
$264.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$908.90
|
| Rate for Payer: Cash Price |
$595.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$895.67
|
| Rate for Payer: Heritage Provider Network Senior |
$895.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.75
|
| Rate for Payer: Multiplan Commercial |
$992.25
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
OP
|
$4,094.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.01 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$818.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,812.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,706.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,045.41
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,661.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,534.19
|
| Rate for Payer: Heritage Provider Network Senior |
$1,393.09
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$1,057.62
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$2,151.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$3,070.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,245.85
|
| Rate for Payer: TriValley Medical Group Senior |
$1,245.85
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,374.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC REPLACE DUODENAL/JEJUN TUBE
|
Facility
IP
|
$4,094.00
|
|
|
Service Code
|
CPT 49451
|
| Hospital Charge Code |
909020006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$741.01 |
| Max. Negotiated Rate |
$3,070.50 |
| Rate for Payer: Adventist Health Commercial |
$818.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,812.58
|
| Rate for Payer: Cash Price |
$1,842.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,771.64
|
| Rate for Payer: Heritage Provider Network Senior |
$2,771.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$741.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,023.50
|
| Rate for Payer: Multiplan Commercial |
$3,070.50
|
|
|
HC REPLACE GAST/CECOSTOMY TUBE
|
Facility
OP
|
$1,845.00
|
|
|
Service Code
|
CPT 49450
|
| Hospital Charge Code |
906749450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$333.94 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$369.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,267.52
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,547.00
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cash Price |
$830.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,199.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: Dignity Health Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$1,132.59
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,249.06
|
| Rate for Payer: Heritage Provider Network Senior |
$1,249.06
|
| Rate for Payer: Humana Medicare |
$1,132.59
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$889.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,336.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$461.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,427.06
|
| Rate for Payer: Multiplan Commercial |
$1,383.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$669.92
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$616.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
