|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
IP
|
$10,980.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,987.38 |
| Max. Negotiated Rate |
$8,235.00 |
| Rate for Payer: Adventist Health Commercial |
$2,196.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$7,071.12
|
| Rate for Payer: Cash Price |
$4,941.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,433.46
|
| Rate for Payer: Heritage Provider Network Senior |
$7,433.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,987.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Multiplan Commercial |
$8,235.00
|
|
|
HC REPAIR FOOT TENDON
|
Facility
|
OP
|
$5,054.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$914.77 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,010.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,123.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,400.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,910.41
|
| Rate for Payer: Cash Price |
$2,274.30
|
| Rate for Payer: Cash Price |
$2,274.30
|
| Rate for Payer: Cash Price |
$2,274.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,285.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,421.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,421.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,410.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$914.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$3,790.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,032.40
|
| Rate for Payer: TriValley Medical Group Senior |
$3,032.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR FOOT TENDON
|
Facility
|
IP
|
$5,054.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
900501722
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$914.77 |
| Max. Negotiated Rate |
$3,790.50 |
| Rate for Payer: Adventist Health Commercial |
$1,010.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,254.78
|
| Rate for Payer: Cash Price |
$2,274.30
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,421.56
|
| Rate for Payer: Heritage Provider Network Senior |
$3,421.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$914.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,263.50
|
| Rate for Payer: Multiplan Commercial |
$3,790.50
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
OP
|
$3,990.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,465.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,895.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,508.22
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,593.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,903.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,394.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,394.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR HAND JOINT
|
Facility
|
IP
|
$3,990.00
|
|
|
Service Code
|
CPT 26540
|
| Hospital Charge Code |
900501397
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$722.19 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$798.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,569.56
|
| Rate for Payer: Cash Price |
$1,795.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,701.23
|
| Rate for Payer: Heritage Provider Network Senior |
$2,701.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$722.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$997.50
|
| Rate for Payer: Multiplan Commercial |
$2,992.50
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
IP
|
$7,750.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,402.75 |
| Max. Negotiated Rate |
$5,812.50 |
| Rate for Payer: Adventist Health Commercial |
$1,550.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,991.00
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,246.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,246.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,402.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,937.50
|
| Rate for Payer: Multiplan Commercial |
$5,812.50
|
|
|
HC REPAIR INTL INGUINAL HERNIA
|
Facility
|
OP
|
$7,750.00
|
|
|
Service Code
|
CPT 49501
|
| Hospital Charge Code |
900501740
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,402.75 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,550.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,789.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,681.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,929.50
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Cash Price |
$3,487.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,037.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,604.99
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,246.75
|
| Rate for Payer: Heritage Provider Network Senior |
$5,246.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,696.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,402.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,295.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,937.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$5,812.50
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,650.00
|
| Rate for Payer: TriValley Medical Group Senior |
$4,650.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
IP
|
$9,810.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,775.61 |
| Max. Negotiated Rate |
$7,357.50 |
| Rate for Payer: Adventist Health Commercial |
$1,962.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,317.64
|
| Rate for Payer: Cash Price |
$4,414.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,641.37
|
| Rate for Payer: Heritage Provider Network Senior |
$6,641.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,775.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,452.50
|
| Rate for Payer: Multiplan Commercial |
$7,357.50
|
|
|
HC REPAIR LACERATION CORNEA/SCLER
|
Facility
|
OP
|
$9,810.00
|
|
|
Service Code
|
CPT 65285
|
| Hospital Charge Code |
900501628
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,775.61 |
| Max. Negotiated Rate |
$10,445.70 |
| Rate for Payer: Adventist Health Commercial |
$1,962.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,062.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,844.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,659.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,708.18
|
| Rate for Payer: Cash Price |
$4,414.50
|
| Rate for Payer: Cash Price |
$4,414.50
|
| Rate for Payer: Cash Price |
$4,414.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,376.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,528.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,844.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,376.50
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,844.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,641.37
|
| Rate for Payer: Heritage Provider Network Senior |
$6,641.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,844.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,679.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,775.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,870.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,452.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,171.08
|
| Rate for Payer: Multiplan Commercial |
$7,357.50
|
| Rate for Payer: Multiplan WC |
$10,445.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,886.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,886.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,844.09
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,967.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,511.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.17
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,068.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,518.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,909.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,909.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC REPAIR LIP, FULL THICKNESS
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 40650
|
| Hospital Charge Code |
900501495
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$2,387.25 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,049.85
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
IP
|
$3,183.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$2,387.25 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,049.85
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
|
|
HC REPAIR MOUTH LACERATION GT 2.5 C
|
Facility
|
OP
|
$3,183.00
|
|
|
Service Code
|
CPT 40831
|
| Hospital Charge Code |
900501471
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$576.12 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$636.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,967.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,511.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,203.17
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cash Price |
$1,432.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,068.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$693.67
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,154.89
|
| Rate for Payer: Heritage Provider Network Senior |
$2,154.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,518.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$576.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$797.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$2,387.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: TriValley Medical Group Commercial |
$1,909.80
|
| Rate for Payer: TriValley Medical Group Senior |
$1,909.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
IP
|
$8,932.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,616.69 |
| Max. Negotiated Rate |
$6,699.00 |
| Rate for Payer: Adventist Health Commercial |
$1,786.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,752.21
|
| Rate for Payer: Cash Price |
$4,019.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,046.96
|
| Rate for Payer: Heritage Provider Network Senior |
$6,046.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,616.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,233.00
|
| Rate for Payer: Multiplan Commercial |
$6,699.00
|
|
|
HC REPAIR MUSCLES OF HAND, EA
|
Facility
|
OP
|
$8,932.00
|
|
|
Service Code
|
CPT 26591
|
| Hospital Charge Code |
900501445
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,616.69 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,786.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,519.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,242.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,376.30
|
| Rate for Payer: Cash Price |
$4,019.40
|
| Rate for Payer: Cash Price |
$4,019.40
|
| Rate for Payer: Cash Price |
$4,019.40
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,805.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,208.34
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,046.96
|
| Rate for Payer: Heritage Provider Network Senior |
$6,046.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,260.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,616.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,233.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,699.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,359.20
|
| Rate for Payer: TriValley Medical Group Senior |
$5,359.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
IP
|
$5,773.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$4,329.75 |
| Rate for Payer: Adventist Health Commercial |
$1,154.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,717.81
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,908.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3,908.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,044.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.25
|
| Rate for Payer: Multiplan Commercial |
$4,329.75
|
|
|
HC REPAIR OF CORNEAL LACERATION
|
Facility
|
OP
|
$5,773.00
|
|
|
Service Code
|
CPT 65280
|
| Hospital Charge Code |
900501665
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,044.91 |
| Max. Negotiated Rate |
$10,445.70 |
| Rate for Payer: Adventist Health Commercial |
$1,154.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,567.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,844.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,742.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,182.19
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Cash Price |
$2,597.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,752.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,528.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,844.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,752.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$6,844.09
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,908.32
|
| Rate for Payer: Heritage Provider Network Senior |
$3,908.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,844.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,753.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,044.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,870.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,443.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,171.08
|
| Rate for Payer: Multiplan Commercial |
$4,329.75
|
| Rate for Payer: Multiplan WC |
$10,445.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,463.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,463.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,266.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,528.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,844.09
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
IP
|
$4,880.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,142.72
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
|
|
HC REPAIR OF EYE/LID WOUND
|
Facility
|
OP
|
$4,880.00
|
|
|
Service Code
|
CPT 65270
|
| Hospital Charge Code |
900501396
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$883.28 |
| Max. Negotiated Rate |
$5,158.00 |
| Rate for Payer: Adventist Health Commercial |
$976.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,015.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,318.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,844.64
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cash Price |
$2,196.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,172.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,172.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$3,057.84
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,303.76
|
| Rate for Payer: Heritage Provider Network Senior |
$3,303.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,327.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$883.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,220.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$3,660.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,928.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,928.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
OP
|
$2,701.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$488.88 |
| Max. Negotiated Rate |
$9,728.00 |
| Rate for Payer: Adventist Health Commercial |
$540.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,669.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,485.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,728.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,962.13
|
| Rate for Payer: Blue Shield of California EPN |
$7,178.49
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,755.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,295.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,295.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,671.92
|
| Rate for Payer: Heritage Provider Network Senior |
$1,671.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,288.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,890.70
|
| Rate for Payer: Multiplan Commercial |
$2,025.75
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$3,544.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,984.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,295.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,295.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,295.85
|
|
|
HC REPAIR OF HEART WOUND
|
Facility
|
IP
|
$2,701.00
|
|
|
Service Code
|
CPT 33300
|
| Hospital Charge Code |
900503330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$488.88 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: Adventist Health Commercial |
$540.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,739.44
|
| Rate for Payer: Cash Price |
$1,215.45
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,828.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,828.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.25
|
| Rate for Payer: Multiplan Commercial |
$2,025.75
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
IP
|
$8,473.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,533.61 |
| Max. Negotiated Rate |
$6,354.75 |
| Rate for Payer: Adventist Health Commercial |
$1,694.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,456.61
|
| Rate for Payer: Cash Price |
$3,812.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,736.22
|
| Rate for Payer: Heritage Provider Network Senior |
$5,736.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,533.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.25
|
| Rate for Payer: Multiplan Commercial |
$6,354.75
|
|
|
HC REPAIR OF THIGH MUSCLE
|
Facility
|
OP
|
$8,473.00
|
|
|
Service Code
|
CPT 27385
|
| Hospital Charge Code |
900501364
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,533.61 |
| Max. Negotiated Rate |
$14,462.30 |
| Rate for Payer: Adventist Health Commercial |
$1,694.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,236.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,024.68
|
| Rate for Payer: Blue Shield of California EPN |
$3,202.79
|
| Rate for Payer: Cash Price |
$3,812.85
|
| Rate for Payer: Cash Price |
$3,812.85
|
| Rate for Payer: Cash Price |
$3,812.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$5,507.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$9,332.70
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,736.22
|
| Rate for Payer: Heritage Provider Network Senior |
$5,736.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,041.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,533.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,732.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,118.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$6,354.75
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,083.80
|
| Rate for Payer: TriValley Medical Group Senior |
$5,083.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
IP
|
$9,540.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,726.74 |
| Max. Negotiated Rate |
$7,155.00 |
| Rate for Payer: Adventist Health Commercial |
$1,908.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$6,143.76
|
| Rate for Payer: Cash Price |
$4,293.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,458.58
|
| Rate for Payer: Heritage Provider Network Senior |
$6,458.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,726.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.00
|
| Rate for Payer: Multiplan Commercial |
$7,155.00
|
|
|
HC REPAIR PALATE LAC GT 2CM
|
Facility
|
OP
|
$9,540.00
|
|
|
Service Code
|
CPT 42182
|
| Hospital Charge Code |
900501332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,726.74 |
| Max. Negotiated Rate |
$11,976.10 |
| Rate for Payer: Adventist Health Commercial |
$1,908.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$5,895.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,531.50
|
| Rate for Payer: Blue Shield of California EPN |
$3,606.12
|
| Rate for Payer: Cash Price |
$4,293.00
|
| Rate for Payer: Cash Price |
$4,293.00
|
| Rate for Payer: Cash Price |
$4,293.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$6,201.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,613.89
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,458.58
|
| Rate for Payer: Heritage Provider Network Senior |
$6,458.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$4,550.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,726.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,755.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,202.61
|
| Rate for Payer: Multiplan Commercial |
$7,155.00
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: TriValley Medical Group Commercial |
$5,724.00
|
| Rate for Payer: TriValley Medical Group Senior |
$5,724.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
