|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
IP
|
$6,591.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$4,943.25 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,244.60
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
|
|
HC REPAIR PROFUNDUS TENDON
|
Facility
|
OP
|
$6,591.00
|
|
|
Service Code
|
CPT 26370
|
| Hospital Charge Code |
900501318
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,192.97 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,318.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,073.24
|
| 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 |
$3,130.72
|
| Rate for Payer: Blue Shield of California EPN |
$2,491.40
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cash Price |
$2,965.95
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,284.15
|
| 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 |
$4,462.11
|
| Rate for Payer: Heritage Provider Network Senior |
$4,462.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,143.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,192.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,647.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$4,943.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,954.60
|
| Rate for Payer: TriValley Medical Group Senior |
$3,954.60
|
| 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 SPICA BODY CAST/JACKET
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$444.75 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$381.89
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
|
|
HC REPAIR SPICA BODY CAST/JACKET
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 29720
|
| Hospital Charge Code |
900501112
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$118.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$366.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$281.68
|
| Rate for Payer: Blue Shield of California EPN |
$224.15
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cash Price |
$266.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$385.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$209.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$401.46
|
| Rate for Payer: Heritage Provider Network Senior |
$401.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$282.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.06
|
| Rate for Payer: Multiplan Commercial |
$444.75
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: TriValley Medical Group Commercial |
$355.80
|
| Rate for Payer: TriValley Medical Group Senior |
$355.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
HC REPAIR TENDON EXTENSOR FOOT EA
|
Facility
|
OP
|
$5,054.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
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 TENDON EXTENSOR FOOT EA
|
Facility
|
IP
|
$5,054.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
900501348
|
|
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 TENDON,LEG PRIM W/O GRF
|
Facility
|
IP
|
$5,215.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$3,911.25 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,358.46
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$943.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
|
|
HC REPAIR TENDON,LEG PRIM W/O GRF
|
Facility
|
OP
|
$5,215.00
|
|
|
Service Code
|
CPT 27658
|
| Hospital Charge Code |
900501503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$943.91 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,043.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,222.87
|
| 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 |
$3,672.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,477.12
|
| Rate for Payer: Blue Shield of California EPN |
$1,971.27
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cash Price |
$2,346.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,389.75
|
| 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 |
$3,530.55
|
| Rate for Payer: Heritage Provider Network Senior |
$3,530.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,487.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$943.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,303.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$3,911.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,129.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,129.00
|
| 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 TENDON/MUSCLE PRIM SNGL
|
Facility
|
OP
|
$7,359.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,547.86
|
| 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 |
$3,495.53
|
| Rate for Payer: Blue Shield of California EPN |
$2,781.70
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,783.35
|
| 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 |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,510.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,839.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: TriValley Medical Group Commercial |
$4,415.40
|
| Rate for Payer: TriValley Medical Group Senior |
$4,415.40
|
| 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 TENDON/MUSCLE PRIM SNGL
|
Facility
|
IP
|
$7,359.00
|
|
|
Service Code
|
CPT 25270
|
| Hospital Charge Code |
900501284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,331.98 |
| Max. Negotiated Rate |
$5,519.25 |
| Rate for Payer: Adventist Health Commercial |
$1,471.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,739.20
|
| Rate for Payer: Cash Price |
$3,311.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,982.04
|
| Rate for Payer: Heritage Provider Network Senior |
$4,982.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,331.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,839.75
|
| Rate for Payer: Multiplan Commercial |
$5,519.25
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
OP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$869.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,687.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,065.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,643.92
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,826.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$304.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,944.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,944.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,074.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$787.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$350.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,609.40
|
| Rate for Payer: TriValley Medical Group Senior |
$2,609.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC REPAIR TONGUE LACERATION GT 2.6C
|
Facility
|
IP
|
$4,349.00
|
|
|
Service Code
|
CPT 41252
|
| Hospital Charge Code |
900501306
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$787.17 |
| Max. Negotiated Rate |
$3,261.75 |
| Rate for Payer: Adventist Health Commercial |
$869.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,800.76
|
| Rate for Payer: Cash Price |
$1,957.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,944.27
|
| Rate for Payer: Heritage Provider Network Senior |
$2,944.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$787.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.25
|
| Rate for Payer: Multiplan Commercial |
$3,261.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$675.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,306.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,773.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,411.07
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,426.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,527.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,527.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,780.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$675.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,239.80
|
| Rate for Payer: TriValley Medical Group Senior |
$2,239.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.67 |
| Max. Negotiated Rate |
$2,799.75 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,404.05
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,527.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,527.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$675.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$675.67 |
| Max. Negotiated Rate |
$2,799.75 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,404.05
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,527.24
|
| Rate for Payer: Heritage Provider Network Senior |
$2,527.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$675.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
|
|
HC REPAIR TUNNEL/NON TUNNEL CV CATH
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
909000255
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$675.67 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,306.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,426.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$806.82
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,310.73
|
| Rate for Payer: Heritage Provider Network Senior |
$992.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$1,532.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$675.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$933.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: TriValley Medical Group Commercial |
$887.50
|
| Rate for Payer: TriValley Medical Group Senior |
$887.50
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
OP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$711.33 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,428.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,158.00
|
| 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 |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,554.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,024.63
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,432.67
|
| Rate for Payer: Heritage Provider Network Senior |
$2,490.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,846.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$711.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,328.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,227.09
|
| Rate for Payer: TriValley Medical Group Senior |
$2,227.09
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,731.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,298.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC REPAIR TUNNEL/NON TUNN W/PORT
|
Facility
|
IP
|
$3,930.00
|
|
|
Service Code
|
CPT 36576
|
| Hospital Charge Code |
909000256
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$711.33 |
| Max. Negotiated Rate |
$2,947.50 |
| Rate for Payer: Adventist Health Commercial |
$786.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$2,530.92
|
| Rate for Payer: Cash Price |
$1,768.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,660.61
|
| Rate for Payer: Heritage Provider Network Senior |
$2,660.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$711.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$982.50
|
| Rate for Payer: Multiplan Commercial |
$2,947.50
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
OP
|
$6,053.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,095.59 |
| Max. Negotiated Rate |
$7,634.30 |
| Rate for Payer: Adventist Health Commercial |
$1,210.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,740.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,056.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,875.18
|
| Rate for Payer: Blue Shield of California EPN |
$2,288.03
|
| Rate for Payer: Cash Price |
$2,723.85
|
| Rate for Payer: Cash Price |
$2,723.85
|
| Rate for Payer: Cash Price |
$2,723.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,934.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,562.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,056.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,934.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$5,056.43
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,097.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,097.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,056.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,887.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,095.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,814.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,775.62
|
| Rate for Payer: Multiplan Commercial |
$4,539.75
|
| Rate for Payer: Multiplan WC |
$7,634.30
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,631.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,631.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,584.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,562.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,056.43
|
|
|
HC REPAIR WOUND EXTRAOCULAR MUSC
|
Facility
|
IP
|
$6,053.00
|
|
|
Service Code
|
CPT 65290
|
| Hospital Charge Code |
900501181
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,095.59 |
| Max. Negotiated Rate |
$4,539.75 |
| Rate for Payer: Adventist Health Commercial |
$1,210.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,898.13
|
| Rate for Payer: Cash Price |
$2,723.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,097.88
|
| Rate for Payer: Heritage Provider Network Senior |
$4,097.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,095.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.25
|
| Rate for Payer: Multiplan Commercial |
$4,539.75
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
OP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,159.31 |
| Max. Negotiated Rate |
$9,616.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,958.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,042.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,421.09
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$4,163.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: EPIC Health Plan Medicare |
$4,061.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,336.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4,336.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$3,055.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,159.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,670.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,843.00
|
| Rate for Payer: TriValley Medical Group Senior |
$3,843.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC REP BLOOD VESSEL HAND, FINGER
|
Facility
|
IP
|
$6,405.00
|
|
|
Service Code
|
CPT 35207
|
| Hospital Charge Code |
900501131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,159.31 |
| Max. Negotiated Rate |
$4,803.75 |
| Rate for Payer: Adventist Health Commercial |
$1,281.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$4,124.82
|
| Rate for Payer: Cash Price |
$2,882.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,336.19
|
| Rate for Payer: Heritage Provider Network Senior |
$4,336.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,159.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,601.25
|
| Rate for Payer: Multiplan Commercial |
$4,803.75
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$916.40 |
| Max. Negotiated Rate |
$10,943.70 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,128.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,245.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,404.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,913.81
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Cigna of CA HMO/PPO |
$3,290.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$7,156.86
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,427.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,427.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial |
$2,415.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$916.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,230.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,265.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: TriValley Medical Group Commercial |
$3,037.80
|
| Rate for Payer: TriValley Medical Group Senior |
$3,037.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC REP BLOOD VESSEL HEAD & NECK
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35201
|
| Hospital Charge Code |
900501619
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$916.40 |
| Max. Negotiated Rate |
$3,797.25 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,260.57
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,427.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,427.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$916.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,265.75
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
|
|
HC REP BLOOD VESSEL UPPER EXT
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
CPT 35206
|
| Hospital Charge Code |
900501130
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$916.40 |
| Max. Negotiated Rate |
$3,797.25 |
| Rate for Payer: Adventist Health Commercial |
$1,012.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,260.57
|
| Rate for Payer: Cash Price |
$2,278.35
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,427.65
|
| Rate for Payer: Heritage Provider Network Senior |
$3,427.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$916.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,265.75
|
| Rate for Payer: Multiplan Commercial |
$3,797.25
|
|
